Cyclic boronic acid ester derivatives and therapeutic uses thereof

ABSTRACT

Method of treating or ameliorating a bacterial infection comprising administering a composition comprising a cyclic boronic acid ester compound in combination with a carbapenem antibacterial agent such as Biapenem, and the pharmacokinetics studies thereof are provided.

INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS

This application claims the benefit of priority to U.S. ProvisionalPatent Application Ser. No. 61/656,452, filed Jun. 6, 2012, which isherein incorporated by reference in its entirety. Any and allapplications for which a foreign or domestic priority claim isidentified in the Application Data Sheet as filed with the presentapplication, or any correction thereto, are hereby incorporated byreference under 37 CFR 1.57.

FIELD

The present invention relates to antimicrobial compounds, compositions,their use and preparation as therapeutic agents. In particular, thepresent invention relates to use of cyclic boronic acid ester compoundsin combination with carbapenems.

BACKGROUND

Antibiotics have been effective tools in the treatment of infectiousdiseases during the last half-century. From the development ofantibiotic therapy to the late 1980s there was almost complete controlover bacterial infections in developed countries. However, in responseto the pressure of antibiotic usage, multiple resistance mechanisms havebecome widespread and are threatening the clinical utility ofanti-bacterial therapy. The increase in antibiotic resistant strains hasbeen particularly common in major hospitals and care centers. Theconsequences of the increase in resistant strains include highermorbidity and mortality, longer patient hospitalization, and an increasein treatment costs.

Various bacteria have evolved β-lactam deactivating enzymes, namely,β-lactamases, that counter the efficacy of the various β-lactams.β-lactamases can be grouped into 4 classes based on their amino acidsequences, namely, Ambler classes A, B, C, and D. Enzymes in classes A,C, and D include active-site serine β-lactamases, and class B enzymes,which are encountered less frequently, are Zn-dependent. These enzymescatalyze the chemical degradation of β-lactam antibiotics, renderingthem inactive. Some β-lactamases can be transferred within and betweenvarious bacterial strains and species. The rapid spread of bacterialresistance and the evolution of multi-resistant strains severely limitsβ-lactam treatment options available.

The increase of class D β-lactamase-expressing bacterium strains such asAcinetobacter baumannii has become an emerging multidrug-resistantthreat. A. baumannii strains express A, C, and D class β-lactamases. Theclass D β-lactamases such as the OXA families are particularly effectiveat destroying carbapenem type β-lactam antibiotics, e.g., imipenem, theactive carbapenems component of Merck's Primaxin® (Montefour, K.; et al.Crit. Care Nurse 2008, 28, 15; Perez, F. et al. Expert Rev. Anti Infect.Ther. 2008, 6, 269; Bou, G.; Martinez-Beltran, J. Antimicrob. AgentsChemother. 2000, 40, 428, 2006, 50, 2280; Bou, G. et al, J. Antimicrob.Agents Chemother. 2000, 44, 1556). This has imposed a pressing threat tothe effective use of drugs in that category to treat and preventbacterial infections. Indeed the number of catalogued serine-basedβ-lactamases has exploded from less than ten in the 1970s to over 300variants. These issues fostered the development of five “generations” ofcephalosporins. When initially released into clinical practice,extended-spectrum cephalosporins resisted hydrolysis by the prevalentclass A β-lactamases, TEM-1 and SHV-1. However, the development ofresistant strains by the evolution of single amino acid substitutions inTEM-1 and SHV-1 resulted in the emergence of the extended-spectrumβ-lactamase (ESBL) phenotype.

New β-lactamases have recently evolved that hydrolyze the carbapenemclass of antimicrobials, including imipenem, biapenem, doripenem,meropenem, and ertapenem, as well as other β-lactam antibiotics. Thesecarbapenemases belong to molecular classes A, B, and D. Class Acarbapenemases of the KPC-type predominantly in Klebsiella pneumoniaebut now also reported in other Enterobacteriaceae, Pseudomonasaeruginosa and Acinetobacter baumannii. The KPC carbapenemase was firstdescribed in 1996 in North Carolina, but since then has disseminatedwidely in the US. It has been particularly problematic in the New YorkCity area, where several reports of spread within major hospitals andpatient morbidity have been reported. These enzymes have also beenrecently reported in France, Greece, Sweden, United Kingdom, and anoutbreak in Germany has recently been reported. Treatment of resistantstrains with carbapenems can be associated with poor outcomes.

Another mechanism of β-lactamase mediated resistance to carbapenemsinvolves combination of permeability or efflux mechanisms combined withhyper production of beta-lactamases. One example is the loss of a porincombined in hyperproduction of ampC beta-lactamase results in resistanceto imipenem in Pseudomonas aeruginosa. Efflux pump over expressioncombined with hyperproduction of the ampC β-lactamase can also result inresistance to a carbapenem such as meropenem.

Because there are three major molecular classes of serine-basedβ-lactamases, and each of these classes contains significant numbers ofβ-lactamase variants, inhibition of one or a small number ofβ-lactamases is unlikely to be of therapeutic value. Legacy β-lactamaseinhibitors are largely ineffective against at least Class Acarbapenemases, against the chromosomal and plasmid-mediated Class Ccephalosporinases and against many of the Class D oxacillinases.Therefore, there is a need for improved β-lactamase inhibitors.

SUMMARY

Some embodiments described herein relate to a method for treating abacterial infection, comprising administering to a subject in needthereof a composition comprising a cyclic boronic acid ester compound Ior a pharmaceutically acceptable salt thereof and a carbapenemantibacterial agent to achieve an in vivo Compound I plasmaconcentration C_(max) from about 1 mg/L to about 500 mg/L.

Some embodiments described herein relate to a method for treating abacterial infection, comprising administering to a subject in needthereof a composition comprising a cyclic boronic acid ester compound Ior a pharmaceutically acceptable salt thereof and a carbapenemantibacterial agent to achieve an in vivo Compound I 24 h AUC from about3 mg*h/L to about 800 mg*h/L.

In some embodiments, the carbapenem antibacterial agent is selected fromthe group consisting of Imipenem, Biapenem, Doripenem, Meropenem, andErtapenem. In some such embodiments, the carbapenem antibacterial agentis Biapenem.

In some embodiments, Compound I is administered in a dosage range fromabout 0.1 mg/kg to about 1000 mg/kg of body weight. In some furtherembodiments, Compound I is administered in a dosage range from about 0.5mg/kg to about 150 mg/kg of body weight.

In some embodiments, the composition is administered intravenously.

In some embodiments, the infection is caused by a bacteria selected fromPseudomonas aeruginosa, Pseudomonas fluorescens, Stenotrophomonasmaltophilia, Escherichia coli, Citrobacter freundii, Salmonellatyphimurium, Salmonella typhi, Salmonella paratyphi, Salmonellaenteritidis, Shigella dysenteriae, Shigella flexneri, Shigella sonnei,Enterobacter cloacae, Enterobacter aerogenes, Klebsiella pneumoniae,Klebsiella oxytoca, Serratia marcescens, Acinetobacter calcoaceticus,Acinetobacter haemolyticus, Yersinia enterocolitica, Yersinia pestis,Yersinia pseudotuberculosis, Yersinia intermedia, Haemophilusinfluenzae, Haemophilus parainfluenzae, Haemophilus haemolyticus,Haemophilus parahaemolyticus, Helicobacter pylori, Campylobacter fetus,Campylobacter jejuni, Campylobacter coli, Vibrio cholerae, Vibrioparahaemolyticus, Legionella pneumophila, Listeria monocytogenes,Neisseria gonorrhoeae, Neisseria meningitidis, Moraxella, Bacteroidesfragilis, Bacteroides vulgatus, Bacteroides ovalus, Bacteroidesthetaiotaomicron, Bacteroides uniformis, Bacteroides eggerthii, orBacteroides splanchnicus.

In some embodiments, the composition further comprises an additionalmedicament selected from an antibacterial agent, antifungal agent, anantiviral agent, an anti-inflammatory agent, or an anti-allergic agent.

In some embodiments, the subject treated by the method described aboveis a mammal. In some further embodiments, the subject is a human.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a graph depicting the plasma concentration profile of 5, 15 or50 mg/kg Compound I as a function of time after administration to SwissWebster mice.

FIG. 2 is a graph depicting the plasma concentration profile of 25 or100 mg/kg Biapenem as a function of time after administration to SwissWebster mice.

FIG. 3 is a graph depicting the plasma concentration profile of 20 mg/kgBiapenem as a function of time after administration to Swiss Webstermice.

FIG. 4 is a graph depicting the plasma concentration profile of 20 mg/kgCompound I as a function of time after administration to Sprague-Dawleyrats.

FIG. 5 is a graph depicting the plasma concentration profile of 20 mg/kgBiapenem in combination with 20 mg/kg Compound I as a function of timeafter administration to Sprague-Dawley rats.

FIG. 6 is a graph depicting the plasma concentration profile of 20 mg/kgCompound I in combination with 20 mg/kg Biapenem as a function of timeafter administration to Sprague-Dawley rats.

DETAILED DESCRIPTION Definitions

The compounds provided herein may encompass various stereochemicalforms. The compounds also encompasses diastereomers as well as opticalisomers, e.g. mixtures of enantiomers including racemic mixtures, aswell as individual enantiomers and diastereomers, which arise as aconsequence of structural asymmetry in certain compounds. Separation ofthe individual isomers or selective synthesis of the individual isomersis accomplished by application of various methods which are well knownto practitioners in the art.

The term “agent” or “test agent” includes any substance, molecule,element, compound, entity, or a combination thereof. It includes, but isnot limited to, e.g., protein, polypeptide, peptide or mimetic, smallorganic molecule, polysaccharide, polynucleotide, and the like. It canbe a natural product, a synthetic compound, or a chemical compound, or acombination of two or more substances. Unless otherwise specified, theterms “agent”, “substance”, and “compound” are used interchangeablyherein.

The term “mammal” is used in its usual biological sense. Thus, itspecifically includes humans, cattle, horses, dogs, cats, rats and micebut also includes many other species.

The term “microbial infection” refers to the invasion of the hostorganism, whether the organism is a vertebrate, invertebrate, fish,plant, bird, or mammal, by pathogenic microbes. This includes theexcessive growth of microbes that are normally present in or on the bodyof a mammal or other organism. More generally, a microbial infection canbe any situation in which the presence of a microbial population(s) isdamaging to a host mammal. Thus, a mammal is “suffering” from amicrobial infection when excessive numbers of a microbial population arepresent in or on a mammal's body, or when the effects of the presence ofa microbial population(s) is damaging the cells or other tissue of amammal. Specifically, this description applies to a bacterial infection.Note that the compounds of preferred embodiments are also useful intreating microbial growth or contamination of cell cultures or othermedia, or inanimate surfaces or objects, and nothing herein should limitthe preferred embodiments only to treatment of higher organisms, exceptwhen explicitly so specified in the claims.

The term “pharmaceutically acceptable carrier” or “pharmaceuticallyacceptable excipient” includes any and all solvents, dispersion media,coatings, antibacterial and antifungal agents, isotonic and absorptiondelaying agents and the like. The use of such media and agents forpharmaceutically active substances is well known in the art. Exceptinsofar as any conventional media or agent is incompatible with theactive ingredient, its use in the therapeutic compositions iscontemplated. Supplementary active ingredients can also be incorporatedinto the compositions. In addition, various adjuvants such as arecommonly used in the art may be included. These and other such compoundsare described in the literature, e.g., in the Merck Index, Merck &Company, Rahway, N.J. Considerations for the inclusion of variouscomponents in pharmaceutical compositions are described, e.g., in Gilmanet al. (Eds.) (1990); Goodman and Gilman's: The Pharmacological Basis ofTherapeutics, 8th Ed., Pergamon Press.

The term “pharmaceutically acceptable salt” refers to salts that retainthe biological effectiveness and properties of the compounds of thepreferred embodiments and, which are not biologically or otherwiseundesirable. In many cases, the compounds of the preferred embodimentsare capable of forming acid and/or base salts by virtue of the presenceof amino and/or carboxyl groups or groups similar thereto.Pharmaceutically acceptable acid addition salts can be formed withinorganic acids and organic acids. Inorganic acids from which salts canbe derived include, for example, hydrochloric acid, hydrobromic acid,sulfuric acid, nitric acid, phosphoric acid, and the like. Organic acidsfrom which salts can be derived include, for example, acetic acid,propionic acid, glycolic acid, pyruvic acid, oxalic acid, maleic acid,malonic acid, succinic acid, fumaric acid, tartaric acid, citric acid,benzoic acid, cinnamic acid, mandelic acid, methanesulfonic acid,ethanesulfonic acid, p-toluenesulfonic acid, salicylic acid, and thelike. Pharmaceutically acceptable base addition salts can be formed withinorganic and organic bases. Inorganic bases from which salts can bederived include, for example, sodium, potassium, lithium, ammonium,calcium, magnesium, iron, zinc, copper, manganese, aluminum, and thelike; particularly preferred are the ammonium, potassium, sodium,calcium and magnesium salts. Organic bases from which salts can bederived include, for example, primary, secondary, and tertiary amines,substituted amines including naturally occurring substituted amines,cyclic amines, basic ion exchange resins, and the like, specificallysuch as isopropylamine, trimethylamine, diethylamine, triethylamine,tripropylamine, and ethanolamine. Many such salts are known in the art,as described in WO 87/05297, Johnston et al., published Sep. 11, 1987(incorporated by reference herein in its entirety).

“Solvate” refers to the compound formed by the interaction of a solventand an EPI, a metabolite, or salt thereof. Suitable solvates arepharmaceutically acceptable solvates including hydrates.

“Subject” as used herein, means a human or a non-human mammal, e.g., adog, a cat, a mouse, a rat, a cow, a sheep, a pig, a goat, a non-humanprimate or a bird, e.g., a chicken, as well as any other vertebrate orinvertebrate.

A therapeutic effect relieves, to some extent, one or more of thesymptoms of the infection, and includes curing an infection. “Curing”means that the symptoms of active infection are eliminated, includingthe elimination of excessive members of viable microbe of those involvedin the infection. However, certain long-term or permanent effects of theinfection may exist even after a cure is obtained (such as extensivetissue damage).

“Treat,” “treatment,” or “treating,” as used herein refers toadministering a pharmaceutical composition for prophylactic and/ortherapeutic purposes. The term “prophylactic treatment” refers totreating a patient who is not yet infected, but who is susceptible to,or otherwise at risk of, a particular infection, whereby the treatmentreduces the likelihood that the patient will develop an infection. Theterm “therapeutic treatment” refers to administering treatment to apatient already suffering from an infection.

Methods of Treatment

Some embodiments described herein relate to a method for treating abacterial infection, comprising administering to a subject in needthereof a composition comprising compound I or a pharmaceuticallyacceptable salt thereof and a carbapenem antibacterial agent to achievean in vivo Compound I plasma concentration C_(max) from about 1 mg/L toabout 500 mg/L. In some embodiments, Compound I plasma concentrationC_(max) achieved by the methods described herein is from about 3 mg/L toabout 400 mg/L. In some embodiments, Compound I plasma concentration C,achieved by the methods described herein is from about 5 mg/L to about300 mg/L. In some embodiments, Compound I plasma concentration C_(max)achieved by the methods described herein is from about 10 mg/L to about200 mg/L. In some embodiments, Compound I plasma concentration C,achieved by the methods described herein is from about 10 mg/L to about50 mg/L.

Some embodiments described herein relate to a method for treating abacterial infection, comprising administering to a subject in needthereof a composition comprising compound I or a pharmaceuticallyacceptable salt thereof and a carbapenem antibacterial agent to achievean in vivo Compound I 24 h AUC from about 3 mg*h/L to about 800 mg*h/L.In some embodiments, Compound I 24 h AUC achieved by the methoddescribed herein is from about 10 mg*h/L to about 700 mg*h/L. In someembodiments, Compound I AUC achieved by the method described herein isfrom about 20 mg*h/L to about 600 mg*h/L. In some embodiments, CompoundI 24 h AUC achieved by the method described herein is from about 45mg*h/L to about 500 mg*h/L.

In some embodiments, the carbapenem antibacterial agent is selected fromthe group consisting of Imipenem, Biapenem, Doripenem, Meropenem, andErtapenem. In some such embodiments, the carbapenem antibacterial agentis Biapenem.

In some embodiments, Compound I is administered in a dosage range fromabout 0.1 mg/kg to about 1000 mg/kg of body weight. In some furtherembodiments, Compound I is administered in a dosage range from about 0.5mg/kg to about 500 mg/kg of body weight. In some embodiments, Compound Iis administered in a dosage range from about 1 mg/kg to about 300 mg/kg.In some embodiments, Compound I is administered in a dosage range fromabout 1.5 mg/kg to about 150 mg/kg.

In some embodiments, Compound I plasma clearance achieved by the methodsdescribed herein is from about 0.01 L/h/kg to about 5 L/h/kg. In someembodiments, Compound I plasma clearance achieved by the methodsdescribed herein is from 0.025 L/hr/kg to about 2.2 L/h/kg. In someembodiments, Compound I plasma clearance achieved by the methodsdescribed herein is from about 0.05 L/h/kg to about 1 L/h/kg.

In some embodiments, Compound I half-life achieved by the methodsdescribed herein is from about 0.05 hr to about 10 hrs. In someembodiments, Compound I half-life achieved by the methods describedherein is from about 0.1 hr to about 7 hrs. In some embodiments,Compound I half-life achieved by the methods described herein is fromabout 0.3 hr to about 5 hrs.

The above-described pharmacokinetic parameters may be achieved via avariety of methods, including by selection of dose, administrationduration (e.g., IV infusion rate), and selection of formulation (e.g.,selection of immediate or sustained-release formulations).

In some embodiments, the composition is administered intravenously.

Some embodiments include co-administering Compound I, its enantiomer,diastereomer, tautomer or pharmaceutically acceptable salt thereof,composition, and/or pharmaceutical composition described herein, with acarbapenem antibacterial agent. By “co-administration,” it is meant thatthe two or more agents may be found in the patient's bloodstream at thesame time, regardless of when or how they are actually administered. Inone embodiment, the agents are administered simultaneously. In one suchembodiment, administration in combination is accomplished by combiningthe agents in a single dosage form. When combining the agents in asingle dosage form, they may be physically mixed (e.g, by co-dissolutionor dry mixing) or may form an adduct or be covalently linked such thatthey split into the two or more active ingredients upon administrationto the patient. In another embodiment, the agents are administeredsequentially. In one embodiment the agents are administered through thesame route, such as orally. In another embodiment, the agents areadministered through different routes, such as one being administeredorally and another being administered i.v.

Further embodiments include administering a combination of Compound I, acarbapenem antibacterial agent, and an additional medicament selectedfrom an antibacterial agent, antifungal agent, an antiviral agent, ananti-inflammatory agent, or an anti-allergic agent to a subject in needthereof.

Some embodiments include co-administration of a combination of CompoundI and a carbapenem antibacterial agent with an additional antibacterialagent such as a β-lactam. In some embodiment, the carbapenemantibacterial agent is Biapenem.

Preferred embodiments of additional medicaments include β-lactams suchas Ceftazidime, Doripenem, Ertapenem, Imipenem, Meropenem, ME1036,Tomopenem, Razupenem, and Panipenem.

Some embodiments include co-administration of a combination of CompoundI and a carbapenem antibacterial agent described herein with anadditional agent, wherein the additional agent comprises a monobactam.Examples of monobactams include aztreonam, tigemonam, BAL 30072, SYN2416 (BAL19764), and carumonam.

Some embodiments include co-administration of a combination of CompoundI and a carbapenem antibacterial agent described herein with anadditional agent, wherein the additional agent comprises a Class A, B,C, or D beta-lactamase inhibitor. An example of a class B beta lactamaseinhibitor includes ME1071 (Yoshikazu Ishii et al, “In Vitro Potentiationof Carbapenems with ME1071, a Novel Metallo-β-Lactamase Inhibitor,against Metallo-β-lactamase Producing Pseudomonas aeruginosa ClinicalIsolates.” Antimicrob. Agents Chemother. doi:10.1128/AAC.01397-09 (July2010)). Other examples of beta-lactamase inhibitors administered as anadditional agent include clavulanic acid, tazobactam, sulbactam,avibactam (NXL-104), MK-7655, BAL29880, SYN-2190, BLI-489, AM-112, andME1071. MK-7655 has the following structure:

Indications

The compositions comprising Compound I and a carbapenem compounddescribed herein can be used to treat bacterial infections. Bacterialinfections that can be treated with a combination of Compound I and acarbapenem antibacterial agent described herein can comprise a widespectrum of bacteria. Example organisms include gram-positive bacteria,gram-negative bacteria, aerobic and anaerobic bacteria, such asStaphylococcus, Lactobacillus, Streptococcus, Sarcina, Escherichia,Enterobacter, Klebsiella, Pseudomonas, Acinetobacter, Mycobacterium,Proteus, Campylobacter, Citrobacter, Nisseria, Baccillus, Bacteroides,Peptococcus, Clostridium, Salmonella, Shigella, Serratia, Haemophilus,Brucella and other organisms.

More examples of bacterial infections include Pseudomonas aeruginosa,Pseudomonas fluorescens, Pseudomonas acidovorans, Pseudomonasalcaligenes, Pseudomonas putida, Stenotrophomonas maltophilia,Burkholderia cepacia, Aeromonas hydrophilia, Escherichia coli,Citrobacter freundii, Salmonella typhimurium, Salmonella typhi,Salmonella paratyphi, Salmonella enteritidis, Shigella dysenteriae,Shigella flexneri, Shigella sonnei, Enterobacter cloacae, Enterobacteraerogenes, Klebsiella pneumoniae, Klebsiella oxytoca, Serratiamarcescens, Francisella tularensis, Morganella morganii, Proteusmirabilis, Proteus vulgaris, Providencia alcalifaciens, Providenciarettgeri, Providencia stuartii, Acinetobacter baumannii, Acinetobactercalcoaceticus, Acinetobacter haemolyticus, Yersinia enterocolitica,Yersinia pestis, Yersinia pseudotuberculosis, Yersinia intermedia,Bordetella pertussis, Bordetella parapertussis, Bordetellabronchiseptica, Haemophilus influenzae, Haemophilus parainfluenzae,Haemophilus haemolyticus, Haemophilus parahaemolyticus, Haemophilusducreyi, Pasteurella multocida, Pasteurella haemolytica, Branhamellacatarrhalis, Helicobacter pylori, Campylobacter fetus, Campylobacterjejuni, Campylobacter coli, Borrelia burgdorferi, Vibrio cholerae,Vibrio parahaemolyticus, Legionella pneumophila, Listeria monocytogenes,Neisseria gonorrhoeae, Neisseria meningitidis, Kingella, Moraxella,Gardnerella vaginalis, Bacteroides fragilis, Bacteroides distasonis,Bacteroides 3452A homology group, Bacteroides vulgatus, Bacteroidesovalus, Bacteroides thetaiotaomicron, Bacteroides uniformis, Bacteroideseggerthii, Bacteroides splanchnicus, Clostridium difficile,Mycobacterium tuberculosis, Mycobacterium avium, Mycobacteriumintracellulare, Mycobacterium leprae, Corynebacterium diphtheriae,Corynebacterium ulcerans, Streptococcus pneumoniae, Streptococcusagalactiae, Streptococcus pyogenes, Enterococcus faecalis, Enterococcusfaecium, Staphylococcus aureus, Staphylococcus epidermidis,Staphylococcus saprophyticus, Staphylococcus intermedius, Staphylococcushyicus subsp. hyicus, Staphylococcus haemolyticus, Staphylococcushominis, or Staphylococcus saccharolyticus.

In some embodiments, the infection is caused by a bacteria selected fromPseudomonas aeruginosa, Pseudomonas fluorescens, Stenotrophomonasmaltophilia, Escherichia coli, Citrobacter freundii, Salmonellatyphimurium, Salmonella typhi, Salmonella paratyphi, Salmonellaenteritidis, Shigella dysenteriae, Shigella flexneri, Shigella sonnei,Enterobacter cloacae, Enterobacter aerogenes, Klebsiella pneumoniae,Klebsiella oxytoca, Serratia marcescens, Acinetobacter calcoaceticus,Acinetobacter haemolyticus, Yersinia enterocolitica, Yersinia pestis,Yersinia pseudotuberculosis, Yersinia intermedia, Haemophilusinfluenzae, Haemophilus parainfluenzae, Haemophilus haemolyticus,Haemophilus parahaemolyticus, Helicobacter pylori, Campylobacter fetus,Campylobacter jejuni, Campylobacter coli, Vibrio cholerae, Vibrioparahaemolyticus, Legionella pneumophila, Listeria monocytogenes,Neisseria gonorrhoeae, Neisseria meningitidis, Moraxella, Bacteroidesfragilis, Bacteroides vulgatus, Bacteroides ovalus, Bacteroidesthetaiotaomicron, Bacteroides uniformis, Bacteroides eggerthii, orBacteroides splanchnicus.

In some embodiments, the composition further comprises an additionalmedicament selected from an antibacterial agent, antifungal agent, anantiviral agent, an anti-inflammatory agent, or an anti-allergic agent.

In some embodiments, the subject treated by the method described aboveis a mammal. In some further embodiments, the subject is a human.

Antibacterial Compounds

Compounds I and II have the structures shown as follows:

In some embodiments, due to the facile exchange of boron esters, thecompounds described herein may convert to or exist in equilibrium withalternate forms. Accordingly, in some embodiments, Compound I may existin combination with one or more of these forms. For example, Compound Imay exist in combination with one or more open-chain form (Formula Ia),dimeric form (Formula Ib), cyclic dimeric form (Formula Ic), trimericform (Formula Id), cyclic trimeric form (Formula Ie), and the like.

Some embodiments include methods for treating or preventing a bacterialinfection comprising administering to a subject in need thereof, aneffective amount of Compound I and a carbapenem antibacterial agent,wherein Compound I can be in any one of the forms described above or acombination thereof. In some embodiments, the carbapenem antibacterialagent is selected from the group consisting of Imipenem, Biapenem,Doripenem, Meropenem, and Ertapenem. In one embodiment, the carbapenemis Biapenem.

Some embodiments include the use of Compound I in combination with acarbapenem antibacterial agent in the preparation of a medicament forthe treatment or prevention of a bacterial infection, wherein Compound Ican be in any one of the forms described above or a combination thereof.In some embodiments, the carbapenem antibacterial agent is selected fromthe group consisting of Imipenem, Biapenem, Doripenem, Meropenem, andErtapenem. In one embodiment, the carbapenem is Biapenem.

Some embodiments further comprise administering an additionalmedicament, either is a separate composition or in the same composition.

In some embodiments, the additional medicament includes an antibacterialagent, antifungal agent, an antiviral agent, an anti-inflammatory agentor an anti-allergic agent.

In some embodiments, the additional medicament comprises anantibacterial agent such as a β-lactam.

In some embodiments, the β-lactam includes Amoxicillin, Ampicillin(Pivampicillin, Hetacillin, Bacampicillin, Metampicillin,Talampicillin), Epicillin, Carbenicillin (Carindacillin), Ticarcillin,Temocillin, Azlocillin, Piperacillin, Mezlocillin, Mecillinam(Pivmecillinam), Sulbenicillin, Benzylpenicillin (G), Clometocillin,Benzathine benzylpenicillin, Procaine benzylpenicillin, Azidocillin,Penamecillin, Phenoxymethylpenicillin (V), Propicillin, Benzathinephenoxymethylpenicillin, Pheneticillin, Cloxacillin (Dicloxacillin,Flucloxacillin), Oxacillin, Meticillin, Nafcillin, Faropenem, Biapenem,Doripenem, Ertapenem, Imipenem, Meropenem, Panipenem, Tomopenem,Razupenem, Cefazolin, Cefacetrile, Cefadroxil, Cefalexin, Cefaloglycin,Cefalonium, Cefaloridine, Cefalotin, Cefapirin, Cefatrizine, Cefazedone,Cefazaflur, Cefradine, Cefroxadine, Ceftezole, Cefaclor, Cefamandole,Cefminox, Cefonicid, Ceforanide, Cefotiam, Cefprozil, Cefbuperazone,Cefuroxime, Cefuzonam, Cefoxitin, Cefotetan, Cefmetazole, Loracarbef,Cefixime, Ceftazidime, Ceftriaxone, Cefcapene, Cefdaloxime, Cefdinir,Cefditoren, Cefetamet, Cefmenoxime, Cefodizime, Cefoperazone,Cefotaxime, Cefpimizole, Cefpiramide, Cefpodoxime, Cefsulodin, Cefteram,Ceftibuten, Ceftiolene, Ceftizoxime, Flomoxef, Latamoxef, Cefepime,Cefozopran, Cefpirome, Cefquinome, Ceftobiprole, Ceftaroline, CXA-101,RWJ-54428, MC-04,546, ME1036, BAL30072, SYN 2416, Ceftiofur, Cefquinome,Cefovecin, Aztreonam, Tigemonam, Carumonam, RWJ-442831, RWJ-333441, orRWJ-333442.

In some embodiments, the β-lactam includes Ceftazidime, Doripenem,Ertapenem, Imipenem, Meropenem, or Panipenem.

Some embodiments include a pharmaceutical composition comprising atherapeutically effective amount of any one of the foregoing compoundsand a pharmaceutically acceptable excipient.

In some embodiments, the β-lactam is selected from Aztreonam, Tigemonam,BAL30072, SYN 2416, or Carumonam.

Administration and Pharmaceutical Compositions

Some embodiments include pharmaceutical compositions comprising: (a) asafe and therapeutically effective amount of compound I, or itscorresponding enantiomer, diastereoisomer or tautomer, orpharmaceutically acceptable salt; (b) a carbapenem antibacterial agent,and (c) a pharmaceutically acceptable carrier. In some embodiments,

Compound I and the carbapenem antibacterial agent are administered at atherapeutically effective dosage, e.g., a dosage sufficient to providetreatment for the disease states previously described. While humandosage levels have yet to be optimized for the compounds of thepreferred embodiments, generally, a daily dose for Compound I is fromabout 0.1 mg/kg to about 1000 mg/kg or more of body weight, from about0.5 mg/kg or less to about 500 mg/kg, from about 1.0 mg/kg to about 300mg/kg of body weight, or from about 1.5 mg/kg to about 150 mg/kg of bodyweight. Thus, for administration to a 70 kg person, the dosage rangewould be from about 7 mg per day to about 70,000 mg per day, from about35 mg per day or less to about 35,000 mg per day or more, from about 70mg per day to about 21,000 mg per day, from about 105 mg per day toabout 10,500 mg per day. The amount of Compound I and the carbapenemantibacterial agent administered will, of course, be dependent on thesubject and disease state being treated, the severity of the affliction,the manner and schedule of administration and the judgment of theprescribing physician.

Administration of the combination comprising Compound I or itscorresponding enantiomer, diastereoisomer, tautomer, or thepharmaceutically acceptable salt thereof and the carbapenemantibacterial agent can be via any of the accepted modes ofadministration for agents that serve similar utilities including, butnot limited to, orally, subcutaneously, intravenously, intranasally,topically, transdermally, intraperitoneally, intramuscularly,intrapulmonarily, vaginally, rectally, or intraocularly. Oral andparenteral administrations are customary in treating the indicationsthat are the subject of the preferred embodiments.

Compound I and the carbapenem antibacterial agent as described above canbe formulated into pharmaceutical compositions for use in treatment ofthese conditions. Standard pharmaceutical formulation techniques areused, such as those disclosed in Remington's The Science and Practice ofPharmacy, 21st Ed., Lippincott Williams & Wilkins (2005), incorporatedby reference in its entirety.

In addition to Compound I and the carbapenem antibacterial agent asdescribed above, some embodiments include compositions containing apharmaceutically-acceptable carrier. The term“pharmaceutically-acceptable carrier”, as used herein, means one or morecompatible solid or liquid filler diluents or encapsulating substances,which are suitable for administration to a mammal. The term“compatible”, as used herein, means that the components of thecomposition are capable of being commingled with the subject compound,and with each other, in a manner such that there is no interaction,which would substantially reduce the pharmaceutical efficacy of thecomposition under ordinary use situations. Pharmaceutically-acceptablecarriers must, of course, be of sufficiently high purity andsufficiently low toxicity to render them suitable for administrationpreferably to an animal, preferably mammal being treated.

Some examples of substances, which can serve aspharmaceutically-acceptable carriers or components thereof, are sugars,such as lactose, glucose and sucrose; starches, such as corn starch andpotato starch; cellulose and its derivatives, such as sodiumcarboxymethyl cellulose, ethyl cellulose, and methyl cellulose; powderedtragacanth; malt; gelatin; talc; solid lubricants, such as stearic acidand magnesium stearate; calcium sulfate; vegetable oils, such as peanutoil, cottonseed oil, sesame oil, olive oil, corn oil and oil oftheobroma; polyols such as propylene glycol, glycerine, sorbitol,mannitol, and polyethylene glycol; alginic acid; emulsifiers, such asthe TWEENS; wetting agents, such sodium lauryl sulfate; coloring agents;flavoring agents; tableting agents, stabilizers; antioxidants;preservatives; pyrogen-free water; isotonic saline; and phosphate buffersolutions.

The choice of a pharmaceutically-acceptable carrier to be used inconjunction with the combination is basically determined by the way thecombination is to be administered.

The compositions described herein are preferably provided in unit dosageform. As used herein, a “unit dosage form” is a composition containingan amount of a compound that is suitable for administration to ananimal, preferably mammal subject, in a single dose, according to goodmedical practice. The preparation of a single or unit dosage formhowever, does not imply that the dosage form is administered once perday or once per course of therapy. Such dosage forms are contemplated tobe administered once, twice, thrice or more per day and may beadministered as infusion over a period of time (e.g., from about 30minutes to about 2-6 hours), or administered as a continuous infusion,and may be given more than once during a course of therapy, though asingle administration is not specifically excluded. The skilled artisanwill recognize that the formulation does not specifically contemplatethe entire course of therapy and such decisions are left for thoseskilled in the art of treatment rather than formulation.

The compositions useful as described above may be in any of a variety ofsuitable forms for a variety of routes for administration, for example,for oral, nasal, rectal, topical (including transdermal), ocular,intracerebral, intracranial, intrathecal, intra-arterial, intravenous,intramuscular, or other parental routes of administration. The skilledartisan will appreciate that oral and nasal compositions comprisecompositions that are administered by inhalation, and made usingavailable methodologies. Depending upon the particular route ofadministration desired, a variety of pharmaceutically-acceptablecarriers well-known in the art may be used. Pharmaceutically-acceptablecarriers include, for example, solid or liquid fillers, diluents,hydrotropies, surface-active agents, and encapsulating substances.Optional pharmaceutically-active materials may be included, which do notsubstantially interfere with the inhibitory activity of the compound.The amount of carrier employed in conjunction with the compound issufficient to provide a practical quantity of material foradministration per unit dose of the compound. Techniques andcompositions for making dosage forms useful in the methods describedherein are described in the following references, all incorporated byreference herein: Modern Pharmaceutics, 4th Ed., Chapters 9 and 10(Banker & Rhodes, editors, 2002); Lieberman et al., PharmaceuticalDosage Forms: Tablets (1989); and Ansel, Introduction to PharmaceuticalDosage Forms 8th Edition (2004). In some embodiments, the pharmaceuticalcompositions are administered intravenously. In some embodiments, thepharmaceutical compositions are administered orally. In some otherembodiments, the pharmaceutical compositions are administeredintraperitoneally.

Various oral dosage forms can be used, including such solid forms astablets, capsules, granules and bulk powders. These oral forms comprisea safe and effective amount, usually at least about 5%, with a maximumof about 90%, of the compound. Tablets can be compressed, tablettriturates, enteric-coated, sugar-coated, film-coated, ormultiple-compressed, containing suitable binders, lubricants, diluents,disintegrating agents, coloring agents, flavoring agents, flow-inducingagents, and melting agents. Liquid oral dosage forms include aqueoussolutions, emulsions, suspensions, solutions and/or suspensionsreconstituted from non-effervescent granules, and effervescentpreparations reconstituted from effervescent granules, containingsuitable solvents, preservatives, emulsifying agents, suspending agents,diluents, sweeteners, melting agents, coloring agents and flavoringagents.

The pharmaceutically-acceptable carrier suitable for the preparation ofunit dosage forms for peroral administration is well-known in the art.Tablets typically comprise conventional pharmaceutically-compatibleadjuvants as inert diluents, such as calcium carbonate, sodiumcarbonate, mannitol, lactose and cellulose; binders such as starch,gelatin and sucrose; disintegrants such as starch, alginic acid andcroscarmellose; lubricants such as magnesium stearate, stearic acid andtalc. Glidants such as silicon dioxide can be used to improve flowcharacteristics of the powder mixture. Coloring agents, such as the FD&Cdyes, can be added for appearance. Sweeteners and flavoring agents, suchas aspartame, saccharin, menthol, peppermint, and fruit flavors, areuseful adjuvants for chewable tablets. Capsules typically comprise oneor more solid diluents disclosed above. The selection of carriercomponents depends on secondary considerations like taste, cost, andshelf stability, which are not critical, and can be readily made by aperson skilled in the art.

Peroral compositions also include liquid solutions, emulsions,suspensions, and the like. The pharmaceutically-acceptable carrierssuitable for preparation of such compositions are well known in the art.Typical components of carriers for syrups, elixirs, emulsions andsuspensions include ethanol, glycerol, propylene glycol, polyethyleneglycol, liquid sucrose, sorbitol and water. For a suspension, typicalsuspending agents include methyl cellulose, sodium carboxymethylcellulose, AVICEL RC-591, tragacanth and sodium alginate; typicalwetting agents include lecithin and polysorbate 80; and typicalpreservatives include methyl paraben and sodium benzoate. Peroral liquidcompositions may also contain one or more components such as sweeteners,flavoring agents and colorants disclosed above.

Such compositions may also be coated by conventional methods, typicallywith pH or time-dependent coatings, such that the subject compound isreleased in the gastrointestinal tract in the vicinity of the desiredtopical application, or at various times to extend the desired action.Such dosage forms typically include, but are not limited to, one or moreof cellulose acetate phthalate, polyvinylacetate phthalate,hydroxypropyl methyl cellulose phthalate, ethyl cellulose, Eudragitcoatings, waxes and shellac.

Compositions described herein may optionally include other drug actives.

Other compositions useful for attaining systemic delivery of the subjectcompounds include sublingual, buccal and nasal dosage forms. Suchcompositions typically comprise one or more of soluble filler substancessuch as sucrose, sorbitol and mannitol; and binders such as acacia,microcrystalline cellulose, carboxymethyl cellulose and hydroxypropylmethyl cellulose. Glidants, lubricants, sweeteners, colorants,antioxidants and flavoring agents disclosed above may also be included.

A liquid composition, which is formulated for topical ophthalmic use, isformulated such that it can be administered topically to the eye. Thecomfort should be maximized as much as possible, although sometimesformulation considerations (e.g. drug stability) may necessitate lessthan optimal comfort. In the case that comfort cannot be maximized, theliquid should be formulated such that the liquid is tolerable to thepatient for topical ophthalmic use. Additionally, an ophthalmicallyacceptable liquid should either be packaged for single use, or contain apreservative to prevent contamination over multiple uses.

For ophthalmic application, solutions or medicaments are often preparedusing a physiological saline solution as a major vehicle. Ophthalmicsolutions should preferably be maintained at a comfortable pH with anappropriate buffer system. The formulations may also containconventional, pharmaceutically acceptable preservatives, stabilizers andsurfactants.

Preservatives that may be used in the pharmaceutical compositionsdisclosed herein include, but are not limited to, benzalkonium chloride,PHMB, chlorobutanol, thimerosal, phenylmercuric, acetate andphenylmercuric nitrate. A useful surfactant is, for example, Tween 80.Likewise, various useful vehicles may be used in the ophthalmicpreparations disclosed herein. These vehicles include, but are notlimited to, polyvinyl alcohol, povidone, hydroxypropyl methyl cellulose,poloxamers, carboxymethyl cellulose, hydroxyethyl cellulose and purifiedwater.

Tonicity adjustors may be added as needed or convenient. They include,but are not limited to, salts, particularly sodium chloride, potassiumchloride, mannitol and glycerin, or any other suitable ophthalmicallyacceptable tonicity adjustor.

Various buffers and means for adjusting pH may be used so long as theresulting preparation is ophthalmically acceptable. For manycompositions, the pH will be between 4 and 9. Accordingly, buffersinclude acetate buffers, citrate buffers, phosphate buffers and boratebuffers. Acids or bases may be used to adjust the pH of theseformulations as needed.

In a similar vein, an ophthalmically acceptable antioxidant includes,but is not limited to, sodium metabisulfite, sodium thiosulfate,acetylcysteine, butylated hydroxyanisole and butylated hydroxytoluene.

Other excipient components, which may be included in the ophthalmicpreparations, are chelating agents. A useful chelating agent is edetatedisodium, although other chelating agents may also be used in place orin conjunction with it.

For topical use, creams, ointments, gels, solutions or suspensions,etc., containing the compound disclosed herein are employed. Topicalformulations may generally be comprised of a pharmaceutical carrier,co-solvent, emulsifier, penetration enhancer, preservative system, andemollient.

For intravenous administration, the compounds and compositions describedherein may be dissolved or dispersed in a pharmaceutically acceptablediluent, such as a saline or dextrose solution. Suitable excipients maybe included to achieve the desired pH, including but not limited toNaOH, sodium carbonate, sodium acetate, HCl, and citric acid. In variousembodiments, the pH of the final composition ranges from 2 to 8, orpreferably from 4 to 7. Antioxidant excipients may include sodiumbisulfite, acetone sodium bisulfite, sodium formaldehyde, sulfoxylate,thiourea, and EDTA. Other non-limiting examples of suitable excipientsfound in the final intravenous composition may include sodium orpotassium phosphates, citric acid, tartaric acid, gelatin, andcarbohydrates such as dextrose, mannitol, and dextran. Furtheracceptable excipients are described in Powell, et al., Compendium ofExcipients for Parenteral Formulations, PDA J Pharm Sci and Tech 1998,52 238-311 and Nema et al., Excipients and Their Role in ApprovedInjectable Products: Current Usage and Future Directions, PDA J PharmSci and Tech 2011, 65 287-332, both of which are incorporated herein byreference in their entirety. Antimicrobial agents may also be includedto achieve a bacteriostatic or fungistatic solution, including but notlimited to phenylmercuric nitrate, thimerosal, benzethonium chloride,benzalkonium chloride, phenol, cresol, and chlorobutanol.

The resulting composition may be infused into the patient over a periodof time. In various embodiments, the infusion time ranges from 5 minutesto continuous infusion, from 10 minutes to 8 hours, from 30 minutes to 4hours, and from 1 hour to 3 hours. In one embodiment, the drug isinfused over a 3 hour period. The infusion may be repeated at thedesired dose interval, which may include, for example, 6 hours, 8 hours,12 hours, or 24 hours.

The compositions for intravenous administration may be provided tocaregivers in the form of one more solids that are reconstituted with asuitable diluent such as sterile water, saline or dextrose in watershortly prior to administration. Reconstituted concentrated solutionsmay be further diluted into a parenteral solutions having a volume offrom about 25 to about 1000 ml, from about 30 ml to about 500 ml, orfrom about 50 ml to about 250 ml. In other embodiments, the compositionsare provided in solution ready to administer parenterally. In stillother embodiments, the compositions are provided in a solution that isfurther diluted prior to administration. In embodiments that includeadministering a combination of a compound described herein and anotheragent, the combination may be provided to caregivers as a mixture, orthe caregivers may mix the two agents prior to administration, or thetwo agents may be administered separately.

The actual dose of the active compounds described herein depends on thespecific compound, and on the condition to be treated; the selection ofthe appropriate dose is well within the knowledge of the skilledartisan.

Kits for Intravenous Administration

Some embodiments include a kit comprising Compound I and a carbapenemantibacterial agent. In some embodiments, the carbapenem antibacterialagent is selected from the group consisting of Imipenem, Biapenem,Doripenem, Meropenem, and Ertapenem. In one embodiment, the carbapenemantibacterial agent is Biapenem.

In one embodiment, both components are provided in a single sterilecontainer. In the case of solids for reconstitution, the agents may bepre-blended and added to the container simultaneously or may bedry-powder filled into the container in two separate steps. In someembodiments, the solids are sterile crystalline products. In otherembodiment, the solids are lyophiles. In one embodiment, both componentsare lyophilized together. Non-limiting examples of agents to aid inlyophilization include sodium or potassium phosphates, citric acid,tartaric acid, gelatin, and carbohydrates such as dextrose, mannitol,and dextran. One embodiment includes non-sterile solids that areirradiated either before or after introduction into the container.

In the case of a liquid, the agents may be dissolved or dispersed in adiluent ready for administration. In another embodiment, the solution ordispersion may be further diluted prior to administration. Someembodiments include providing the liquid in an IV bag. The liquid may befrozen to improve stability.

In one embodiment, the container includes other ingredients such as a pHadjuster, a solubilizing agent, or a dispersing agent. Non-limitingexamples of pH adjusters include NaOH, sodium carbonate, sodium acetate,HCl, and citric acid.

The molar ratio of compound I described herein to additional agent(e.g., antibacterial agent) may be from about 20:1 to 1:20, 8:1 to 1:8,5:1 to 1:5, 3:1 to 1:3, 2:1 to 1:2, or about 1:1. In various embodimentsthe amount of compound I described herein may be from 100 mg to 10 g,500 mg to 5 g, or about 2 g. Similarly, in various embodiments theamount of additional agent may be from 100 mg to 5 g, 500 mg to 2 g, orabout 1 g.

In an alternative embodiment, the two components may be provided inseparate containers. Each container may include a solid, solution, ordispersion. In such embodiments, the two containers may be provided in asingle package or may be provided separately. In one embodiment, thecompound described herein is provided as a solution while the additionalagent (e.g., antibacterial agent) is provided as a solid ready forreconstitution. In one such embodiment, the solution of the compounddescribed herein is used as the diluent to reconstitute the other agent.

In some embodiments, the kit may comprise comprises one or moreadditional medicaments selected from an antibacterial agent, antifungalagent, an antiviral agent, an anti-inflammatory agent, or ananti-allergic agent. The additional medicaments can be prepared in thesame way as described above.

The following examples will further describe the present invention, andare used for the purposes of illustration only, and should not beconsidered as limiting.

EXAMPLES General Procedures

Materials used in preparing Compound I and its enantiomer,diastereoisomer or tautomer, or pharmaceutically acceptable saltdescribed herein may be made by known methods or are commerciallyavailable. It will be apparent to the skilled artisan that methods forpreparing precursors and functionality related to the compounds claimedherein are generally described in the literature including, for example,procedures described in U.S. Pat. No. 7,271,186 and WO 2009/064414, eachof which is incorporated by reference in its entirety. In thesereactions, it is also possible to make use of variants which arethemselves known to those of ordinary skill in this art, but are notmentioned in greater detail. The skilled artisan given the literatureand this disclosure is well equipped to prepare any of the compounds.

Trademarks used herein are examples only and reflect illustrativematerials used at the time of the invention. The skilled artisan willrecognize that variations in lot, manufacturing processes, and the like,are expected. Hence the examples, and the trademarks used in them arenon-limiting, and they are not intended to be limiting, but are merelyan illustration of how a skilled artisan may choose to perform one ormore of the embodiments of the invention.

Example 1

Example 1 provides a summary of three pharmacokinetic studies Compound Iconducted in Swiss-webster mice. The pharmacokinetics of 5 mg/kg, 15mg/kg and 50 mg/kg of Compound I via the intraperitoneal route werediscussed.

Materials and Methods

Compound I was prepared using the method described in the U.S.Publication 2012/0040932 A1. 100 mg of Compound I was dissolved in 30%1N NaOH to ˜pH 5.0 as a stock solution. Compound I was further dilutedin 0.9% saline to achieve target concentrations.

The specifications for animals used on this study were as follows:

Species: Mouse Strain: CFW (Swiss) Gender: Female Source: HarlanLaboratories (Livermore, CA) Number of Animals: 33 for each dose BodyWeight Range: 18-22 g at the start of the study

Upon receipt, animals were housed 4 per cage in a room with a controlledenvironment and were acclimated to laboratory conditions for at least 24hours prior to the start of dosing. Animals were provided food and waterad libitum. The health status of the animals was determined during theacclimation period and unhealthy animals were not placed on study. Eachanimal was identified by marking their tails with indelible ink and eachcage was identified by animal, group, and study number.

After acclimation, mice were administered a single intraperitoneal doseof Compound I at 5, 15, and 50 mg/kg. Groups of three mice weresacrificed at 0.08, 0.16, 0.25, 0.33, 0.5, 0.75, 1.0, 2.0, 3.0, and 4.0h after dosing. Blood samples (one sample per animal) were collected bycardiac puncture in a heparin containing tube. Blood samples werecentrifuged within 5 min of collection at 12000 g for 5 min to obtainplasma. The plasma samples were stored on −80° C. until analyzed.

Compound I standard curves were prepared in plasma from 0.1 to 100μg/mL. 50 μl aliquots of sample were placed in 1.5 mL microcentrifugetubes. 20 μl of Compound II (10 μg/mL) was added as internal standard toeach sample or standard. 20 μl of 30% trichloroacetic acid was thenadded to each sample or standard. The samples were mixed using a vortexmixer centrifuged for 10 min at 15,000 RPM using a tabletop centrifuge.The supernatant (approx. 120 μl) was removed and added to 100 μl ofwater in a 96-well plate. The samples were mixed again using a vortexmixer. 10 μl of each sample was injected onto an HPLC-MS forquantification.

The HPLC-MS conditions for plasma analysis are as follows:

Column: Phenomenex Fusion-RP or equivalent reversed-phase column, 5 um,50 × 2 mm. Flow rate: 0.6 mL/min. Mobile phase A: 0.1% formic acid inwater. Mobile phase B: 0.1% formic acid in acetonitrile. Gradient: 5-60%B in 1.5 min. Mass spectrometer: Negative ion mode with electrosprayionization. MS/MS: Compound I − Q1 − m/e = 296, Q3 − m/e = 234. CompoundII − Q1 − m/e = 331, Q3 − m/e = 201.

Plasma concentrations were fit using a one compartment IV infusion model(WinNonlinVersion 5.3, Pharsight Corp, and Mountain View, Calif.).

The study groups, dose and dose route are illustrated in the tablebelow:

Number of Dose Animal per Route of (mg/kg) Time Points (hr) TimepointAdministration 5 0.08, 0.16, 0.25, 0.33, 0.5, 3 Intraperitoneal 0.75,1.0, 2.0, 3.0, 4.0 15 0.08, 0.16, 0.25, 0.33, 0.5, 3 Intraperitoneal0.75, 1.0, 2.0, 3.0, 4.0 50 0.08, 0.16, 0.25, 0.33, 0.5, 3Intraperitoneal 0.75, 1.0, 2.0, 3.0, 4.0Results

The summary of the plasma pharmacokinetics of intraperitoneal dose of 5,15, and 50 mg/kg of Compound I in Swiss Webster mice are shown in FIG. 1and Table 1.

TABLE 1 Plasma Pharmacokinetic Parameters of Compound I in Swiss-WebsterMice Dose Cl AUC Cmax T_(1/2) (mg/kg) (l/hr/kg) (hr * mg/kg) (mg/l) (h)5 1.61 3.1 8.26 0.16 15 1.8 8.3 19.5 0.2 50 1.6 31.35 67.09 0.25

The plasma standard curves of all three studies were linear and used todetermine the plasma concentrations. The plasma standard curve andconcentrations are shown in Table 2-7. The pharmacokinetic profile ofCompound I was assessed in mice after single intraperitoneal doses of 5,15, and 50 mg/kg. Data indicate that Compound I has a linear PK inSwiss-Webster mice over the dose range of 5 to 50 mg/kg.

TABLE 2 Plasma Standard Curve for Pharmacokinetics of 5 mg/kg ofCompound I Analyte Analyte Analyte Peak Conc. Retent. IS Peak Area Calc.Conc. Sample Name Area (counts) (ug/mL) Time (min) Area Ratio (counts)(ug/mL) wash 0 N/A 0 #DIV/0! 0.00E+00 #DIV/0! ctl rat plasma 0 N/A 0#DIV/0! 0.00E+00 #DIV/0! ctl rat plasma w/ Gati 0 N/A 0 0.00E+001.63E+04 No Peak 0.1 ug/ml m.p. Compound I 5910 N/A 1.62 3.71E−011.59E+04 0.152 0.2 ug/ml m.p. Compound I 12100 N/A 1.62 6.41E−011.88E+04 0.264 0.5 ug/ml m.p. Compound I 32600 N/A 1.59 1.67E+001.95E+04 0.691 1 ug/ml m.p. Compound I 63500 1 1.63 2.81E+00 2.26E+041.16 2 ug/ml m.p. Compound I 122000 2 1.62 5.47E+00 2.23E+04 2.28 5ug/ml m.p. Compound I 326000 N/A 1.63 1.43E+01 2.28E+04 6.03 10 ug/mlm.p. Compound I 657000 10 1.63 2.69E+01 2.44E+04 11.5 20 ug/ml m.p.Compound I 1280000 20 1.63 5.06E+01 2.52E+04 22.3 50 ug/ml m.p. CompoundI 2780000 50 1.63 1.18E+02 2.35E+04 58.1 100 ug/ml m.p. Compound I4890000 100 1.63 1.91E+02 2.56E+04 114 wash 17300 N/A 1.57 #DIV/0!0.00E+00 #DIV/0!

TABLE 3 Plasma Concentrations for Pharmacokinetics of 5 mg/kg ofCompound I Analyte Analyte Peak Analyte Retent. Area Conc. Time IS PeakArea Calc. Conc. Sample Name (counts) (ug/mL) (min) Area Ratio (counts)(ug/mL) m.p. 1.1 no dil. (5 mg/kg) 405000 N/A 1.64 1.37E+01 2.96E+045.77 m.p. 1.2 no dil. (5 mg/kg) 368000 N/A 1.63 1.15E+01 3.19E+04 4.84m.p. 1.3 no dil. (5 mg/kg) 423000 N/A 1.63 1.33E+01 3.19E+04 5.58 m.p.2.1 no dil. (5 mg/kg) 687000 N/A 1.63 2.27E+01 3.02E+04 9.68 m.p. 2.2 nodil. (5 mg/kg) 549000 N/A 1.63 1.75E+01 3.13E+04 7.41 m.p. 2.3 no dil.(5 mg/kg) 276000 N/A 1.62 8.36E+00 3.30E+04 3.49 m.p. 3.1 no dil. (5mg/kg) 662000 N/A 1.62 2.14E+01 3.10E+04 9.08 m.p. 3.2 no dil. (5 mg/kg)548000 N/A 1.63 1.76E+01 3.12E+04 7.43 m.p. 3.3 no dil. (5 mg/kg) 279000N/A 1.62 9.07E+00 3.08E+04 3.8 m.p. 4.1 no dil. (5 mg/kg) 243000 N/A1.61 8.07E+00 3.02E+04 3.37 m.p. 4.2 no dil. (5 mg/kg) 79100 N/A 1.612.43E+00 3.26E+04 1.01 m.p. 4.3 no dil. (5 mg/kg) 139000 N/A 1.624.49E+00 3.10E+04 3.73 m.p. 5.1 no dil. (5 mg/kg) 111000 N/A 1.623.74E+00 2.98E+04 1.55 m.p. 5.2 no dil. (5 mg/kg) 147000 N/A 1.614.50E+00 3.26E+04 1.87 m.p. 5.3 no dil. (5 mg/kg) 102000 N/A 1.623.16E+00 3.22E+04 1.31 m.p. 6.1 no dil. (5 mg/kg) 8470 N/A 1.61 2.69E−013.14E+04 0.110 m.p. 6.2 no dil. (5 mg/kg) 72300 N/A 1.62 2.10E+003.44E+04 0.872 m.p. 6.3 no dil. (5 mg/kg) 35900 N/A 1.61 1.11E+003.22E+04 0.461 m.p. 7.1 no dil. (5 mg/kg) 42600 N/A 1.62 1.33E+003.19E+04 0.551 m.p. 7.2 no dil. (5 mg/kg) 17400 N/A 1.6 5.17E−013.36E+04 0.213 m.p. 7.3 no dil. (5 mg/kg) 35800 N/A 1.61 1.11E+003.24E+04 0.457 m.p. 8.1 no dil. (5 mg/kg) 7390 N/A 1.61 2.21E−013.34E+04 0.0898 m.p. 8.2 no dil. (5 mg/kg) 3170 N/A 1.58 1.02E−013.10E+04 0.0404 m.p. 8.3 no dil. (5 mg/kg) 3330 N/A 1.6 1.11E−013.00E+04 0.0440 m.p. 9.1 no dil. (5 mg/kg) 938 N/A 1.57 2.96E−023.17E+04 0.0103 m.p. 9.2 no dil. (5 mg/kg) 2860 N/A 1.62 9.02E−023.17E+04 0.0354 m.p. 9.3 no dil. (5 mg/kg) 805 N/A 1.6 2.42E−02 3.32E+040.00806 m.p. 10.1 no dil. (5 mg/kg) 387 N/A 1.55 1.37E−02 2.82E+040.00371 m.p. 10.2 no dil. (5 mg/kg) 584 N/A 1.61 1.87E−02 3.12E+040.00577 m.p. 10.3 no dil. (5 mg/kg) 463 N/A 1.64 1.49E−02 3.12E+040.00418

TABLE 4 Plasma Standard Curve for Pharmacokinetics of 15 mg/kg ofCompound I Analyte Analyte Analyte Retent. IS Peak Calc. Peak Area Conc.Time Area Conc. Sample Name (counts) (ug/mL) (min) Area Ratio (counts)(ug/mL) wash 0 N/A 0 #DIV/0! 0.00E+00 #DIV/0! ctl rat plasma 0 N/A 0#DIV/0! 0.00E+00 #DIV/0! ctl rat plasma w/ Gati 0 N/A 0 0.00E+002.88E+04 No Peak 0.1 ug/ml m.p. Compound I 9010 N/A 1.58 3.18E−012.84E+04 0.130 0.2 ug/ml m.p. Compound I 14400 0.2 1.6 4.93E−01 2.93E+040.215 0.5 ug/ml m.p. Compound I 32300 0.5 1.6 1.14E+00 2.84E+04 0.531 1ug/ml m.p. Compound I 61500 1 1.6 2.14E+00 2.87E+04 1.02 2 ug/ml m.p.Compound I 116000 2 1.6 4.10E+00 2.83E+04 1.98 5 ug/ml m.p. Compound I304000 5 1.6 1.08E+01 2.82E+04 5.29 10 ug/ml m.p. Compound I 610000 101.6 2.09E+01 2.92E+04 10.4 20 ug/ml m.p. Compound I 1100000 20 1.63.80E+01 2.89E+04 19.4 50 ug/ml m.p. Compound I 2510000 50 1.6 9.07E+012.77E+04 50.6 100 ug/ml m.p. Compound I 4390000 100 1.6 1.58E+022.78E+04 105 wash 16500 N/A 1.53 #DIV/0! 0.00E+00 #DIV/0!

TABLE 5 Plasma Concentrations for Pharmacokinetics of 15 mg/kg ofCompound I Analyte Analyte Peak Analyte Retent. IS Peak Calc. Area Conc.Time Area Conc. Sample Name (counts) (ug/mL) (min) Area Ratio (counts)(ug/mL) m.p. 1.1 no dil. (15 mg/kg) 570000 N/A 1.61 1.95E+01 2.93E+049.67 m.p. 1.2 no dil. (15 mg/kg) 4800000 N/A 1.6 1.60E+02 3.00E+04 m.p.1.3 no dil. (15 mg/kg) 983000 N/A 1.6 3.30E+01 2.98E+04 16.7 m.p. 2.1 nodil. (15 mg/kg) 961000 N/A 1.61 3.07E+01 3.13E+04 15.5 m.p. 2.2 no dil.(15 mg/kg) 517000 N/A 1.61 1.73E+01 2.98E+04 8.58 m.p. 2.3 no dil. (15mg/kg) 19500 N/A 1.56 6.42E−01 3.04E+04 m.p. 3.1 no dil. (15 mg/kg)586000 N/A 1.61 1.92E+01 3.05E+04 9.53 m.p. 3.2 no dil. (15 mg/kg)371000 N/A 1.61 1.14E+01 3.26E+04 5.59 m.p. 3.3 no dil. (15 mg/kg)865000 N/A 1.6 2.84E+01 3.05E+04 14.3 m.p. 4.1 no dil. (15 mg/kg) 348000N/A 1.61 1.14E+01 3.04E+04 5.6 m.p. 4.2 no dil. (15 mg/kg) 756000 N/A1.61 2.46E+01 3.08E+04 12.3 m.p. 4.3 no dil. (15 mg/kg) 284000 N/A 1.619.08E+00 3.13E+04 4.44 m.p. 5.1 no dil. (15 mg/kg) 269000 N/A 1.68.34E+00 3.23E+04 4.07 m.p. 5.2 no dil. (15 mg/kg) 218000 N/A 1.597.24E+00 3.02E+04 3.52 m.p. 5.3 no dil. (15 mg/kg) 444000 N/A 1.591.43E+01 3.11E+04 7.05 m.p. 6.1 no dil. (15 mg/kg) 3150 N/A 1.571.03E−01 3.04E+04 0.0261 m.p. 6.2 no dil. (15 mg/kg) 241000 N/A 1.617.64E+00 3.15E+04 3.72 m.p. 6.3 no dil. (15 mg/kg) 190000 N/A 1.616.15E+00 3.09E+04 2.99 m.p. 7.1 no dil. (15 mg/kg) 31700 N/A 1.561.15E+00 2.76E+04 0.534 m.p. 7.2 no dil. (15 mg/kg) 146000 N/A 1.614.70E+00 3.11E+04 2.28 m.p. 7.3 no dil. (15 mg/kg) 102000 N/A 1.63.36E+00 3.03E+04 1.61 m.p. 8.1 no dil. (15 mg/kg) 9560 N/A 1.583.09E−01 3.09E+04 0.126 m.p. 8.2 no dil. (15 mg/kg) 10000 N/A 1.63.48E−01 2.88E+04 0.145 m.p. 8.3 no dil. (15 mg/kg) 7670 N/A 1.62.40E−01 3.19E+04 0.0926 m.p. 9.1 no dil. (15 mg/kg) 1130 N/A 1.623.77E−02 2.99E+04 <0 m.p. 9.2 no dil. (15 mg/kg) 1290 N/A 1.55 3.98E−023.25E+04 <0 m.p. 9.3 no dil. (15 mg/kg) 2700 N/A 1.56 8.63E−02 3.13E+040.0178 m.p. 10.1 no dil. (15 mg/kg) 546 N/A 1.6 1.87E−02 2.91E+04 <0m.p. 10.2 no dil. (15 mg/kg) 1030 N/A 1.6 3.29E−02 3.12E+04 <0 m.p. 10.3no dil. (15 mg/kg) 752 N/A 1.6 2.54E−02 2.97E+04 <0

TABLE 6 Plasma Standard Curve for Pharmacokinetics of 50 mg/kg ofCompound I Analyte Analyte Retent. IS Peak Analyte Peak Conc. Time AreaCalc. Conc. Sample Name Area (counts) (ug/mL) (min) Area Ratio (counts)(ug/mL) wash 0 N/A 0 #DIV/0! 0.00E+00 #DIV/0! ctl rat plasma 0 N/A 0#DIV/0! 0.00E+00 #DIV/0! ctl rat plasma w/ Gati 0 N/A 0 0.00E+002.27E+04 No Peak 0.1 ug/ml m.p. Compound I 7570 0.1 1.55 3.57E−012.12E+04 0.0994 0.2 ug/ml m.p. Compound I 15600 0.2 1.55 7.12E−012.19E+04 0.213 0.5 ug/ml m.p. Compound I 39500 0.5 1.55 1.76E+002.24E+04 0.549 1 ug/ml m.p. Compound I 78300 1 1.55 3.37E+00 2.32E+041.07 2 ug/ml m.p. Compound I 159000 2 1.55 6.74E+00 2.37E+04 2.16 5ug/ml m.p. Compound I 385000 5 1.55 1.57E+01 2.45E+04 5.16 10 ug/ml m.p.Compound I 716000 10 1.55 3.21E+01 2.23E+04 10.9 20 ug/ml m.p. CompoundI 1390000 20 1.57 5.82E+01 2.39E+04 20.9 50 ug/ml m.p. Compound I3000000 50 1.58 1.25E+02 2.40E+04 56.7 100 ug/ml m.p. Compound I 4870000N/A 1.57 2.36E+02 2.06E+04 No Intercept wash 9190 N/A 1.5 #DIV/0!0.00E+00 #DIV/0!

TABLE 7 Plasma Concentrations for Pharmacokinetics of 50 mg/kg ofCompound I Analyte Analyte Analyte Retent. IS Peak Peak Area Conc. TimeArea Calc. Conc. Sample Name (counts) (ug/mL) (min) Area Ratio (counts)(ug/mL) m.p. 1.1 no dil. 2530000 N/A 1.59 9.78E+01 2.59E+04 39.4 m.p.1.2 no dil. 2110000 N/A 1.6 7.15E+01 2.95E+04 26.6 m.p. 1.3 no dil.2350000 N/A 1.59 8.89E+01 2.64E+04 34.8 m.p. 2.1 5X dil. (50 mg/kg)686000 N/A 1.59 2.36E+01 2.91E+04 58.9 m.p. 2.2 5X dil. (50 mg/kg)744000 N/A 1.59 2.58E+01 2.89E+04 64.7 m.p. 2.3 5X dil. (50 mg/kg)673000 N/A 1.59 2.31E+01 2.91E+04 57.7 m.p. 3.1 5X dil. (50 mg/kg)727000 N/A 1.59 2.56E+01 2.84E+04 64.2 m.p. 3.2 5X dil. (50 mg/kg)677000 N/A 1.59 2.27E+01 2.98E+04 56.8 m.p. 3.3 5X dil. (50 mg/kg)751000 N/A 1.58 2.46E+01 3.05E+04 61.7 m.p. 4.1 no dil. 2610000 N/A 1.591.03E+02 2.54E+04 42.1 m.p. 4.2 5X dil. (50 mg/kg) 1360000 N/A 1.595.18E+01 2.64E+04 m.p. 4.3 no dil. 2690000 N/A 1.6 1.05E+02 2.55E+0443.6 m.p. 5.1 no dil. 2450000 N/A 1.6 8.87E+01 2.76E+04 34.7 m.p. 5.2 nodil. (50 mg/kg) 248000 N/A 1.6 8.31E+00 2.99E+04 m.p. 5.3 no dil.1950000 N/A 1.6 7.25E+01 2.69E+04 27.0 m.p. 6.1 no dil. 1440000 N/A 1.595.38E+01 2.68E+04 19.1 m.p. 6.2 no dil. 974000 N/A 1.58 3.35E+012.91E+04 11.4 m.p. 6.3 no dil. 1160000 N/A 1.59 4.32E+01 2.70E+04 15.0m.p. 7.1 no dil. 739000 N/A 1.59 2.76E+01 2.68E+04 9.26 m.p. 7.2 no dil.206000 N/A 1.55 7.25E+00 2.84E+04 2.33 m.p. 7.3 no dil. 125000 N/A 1.594.40E+00 2.85E+04 1.40 m.p. 8.1 no dil. 46300 N/A 1.54 1.78E+00 2.61E+040.555 m.p. 8.2 no dil. 111000 N/A 1.55 4.07E+00 2.73E+04 1.30 m.p. 8.3no dil. 57100 N/A 1.55 1.86E+00 3.07E+04 0.582 m.p. 9.1 no dil. 16300N/A 1.56 6.13E−01 2.66E+04 0.181 m.p. 9.2 no dil. 11700 N/A 1.564.23E−01 2.76E+04 0.120 m.p. 9.3 no dil. 11900 N/A 1.54 3.75E−013.18E+04 0.105 m.p. 10.1 no dil. 5360 N/A 1.55 1.94E−01 2.76E+04 0.0471m.p. 10.2 no dil. 13600 N/A 1.56 4.92E−01 2.77E+04 0.143 m.p. 10.3 nodil. 19000 N/A 1.55 6.67E−01 2.85E+04 0.199

TABLE 8 Re-assay of Standard Curve and Plasma for Pharmacokinetics of 50mg/kg of Compound I Analyte Analyte Analyte Retent. IS Peak Peak AreaConc. Time Area Calc. Conc. Sample Name (counts) (ug/mL) (min) AreaRatio (counts) (ug/mL) wash 0 N/A 0 #DIV/0! 0.00E+00 #DIV/0! ctl ratplasma 0 N/A 0 #DIV/0! 0.00E+00 #DIV/0! ctl rat plasma w/ Gati 0 N/A 00.00E+00 2.88E+04 No Peak 0.1 ug/ml m.p. Compound I 9010 N/A 1.583.18E−01 2.84E+04 0.13 0.2 ug/ml m.p. Compound I 14400 0.2 1.6 4.93E−012.93E+04 0.215 0.5 ug/ml m.p. Compound I 32300 0.5 1.6 1.14E+00 2.84E+040.531 1 ug/ml m.p. Compound I 61500 1 1.6 2.14E+00 2.87E+04 1.02 2 ug/mlm.p. Compound I 116000 2 1.6 4.10E+00 2.83E+04 1.98 5 ug/ml m.p.Compound I 304000 5 1.6 1.08E+01 2.82E+04 5.29 10 ug/ml m.p. Compound I610000 10 1.6 2.09E+01 2.92E+04 10.4 20 ug/ml m.p. Compound I 1100000 201.6 3.80E+01 2.89E+04 19.4 50 ug/ml m.p. Compound I 2510000 50 1.69.07E+01 2.77E+04 50.6 100 ug/ml m.p. Compound I 4390000 100 1.61.58E+02 2.78E+04 105 wash 16500 N/A 1.53 #DIV/0! 0.00E+00 #DIV/0! m.p.2.1 5X dil. (50 mg/kg) 686000 N/A 1.59 2.36E+01 2.91E+04 58.9 m.p. 2.25X dil. (50 mg/kg) 744000 N/A 1.59 2.58E+01 2.89E+04 64.7 m.p. 2.3 5Xdil. (50 mg/kg) 673000 N/A 1.59 2.31E+01 2.91E+04 57.7 m.p. 3.1 5X dil.(50 mg/kg) 727000 N/A 1.59 2.56E+01 2.84E+04 64.2 m.p. 3.2 5X dil. (50mg/kg) 677000 N/A 1.59 2.27E+01 2.98E+04 56.8 m.p. 3.3 5X dil. (50mg/kg) 751000 N/A 1.58 2.46E+01 3.05E+04 61.7 m.p. 4.2 5X dil. (50mg/kg) 1360000 N/A 1.59 5.18E+01 2.64E+04 135 m.p. 5.2 5X dil. (50mg/kg) 248000 N/A 1.6 8.31E+00 2.99E+04 4.06

Example 2

Example 2 provides a summary of two pharmacokinetic studies of Biapenemconducted in Swiss-webster mice. The pharmacokinetics of 100 mg/kg and25 mg/kg of Biapenem via the intraperitoneal route was discussed below.

Materials and Methods

Biapenem power was purchased from Hisun Pharmaceuticals. 20 mg ofBiapenem was dissolved in 0.1 M NaH₂PO₄ for a basic stock solution. Foranimal studies, this stock solution was further diluted in 0.9% salineto the appropriate concentration.

The specifications for animals used on this study were as follows:

Species: Mouse Strain: CFW (Swiss) Gender: Female Source: HarlanLaboratories (Livermore, CA) Number of Animals: 33 for each dose BodyWeight Range: 18-22 g at the start of the study

Upon receipt, animals were housed 4 per cage in a room with a controlledenvironment and were acclimated to laboratory conditions for at least 24hours prior to the start of dosing. Animals were provided food and waterad libitum. The health status of the animals was determined during theacclimation period and unhealthy animals were not placed on study. Eachanimal was identified by marking their tails with indelible ink and eachcage was identified by animal, group, and study number.

After acclimation, mice were administered a single intraperitoneal doseof biapenem at 25 or 100 mg/kg. Groups of three mice were sacrificed at0.08, 0.17, 0.25, 0.33, 0.5, 0.75, 1.0, 3.0, and 6.0 h after dosing.Blood samples (one sample per animal) were collected by cardiac puncturein a heparin containing tube. The collected heparin tubes werecentrifuged within 5 min of collection at 12000 g for 5 min to obtainplasma. The plasma samples were stored on −80° C. until analyzed.

Biapenem standard curves were prepared in 50% plasma-50% 1M MOPS buffer,pH=7.4 from 1 to 250 ug/mL. 20 uL of sample or standard was added into a96-well deep well plate. Then 500 uL of 10% water-45% methanol-45%acetonitrile containing 2 ug/mL of meropenem was used as an internalstandard. The plate was vortexed for 15 min. at 3,000 RPM. 50 uL ofsupernatant was removed and added 300 uL of water. 10 uL of samples wereinjected onto an HPLC-MS system for quantification.

The HPLC-MS conditions for the Biapenem plasma analysis are as follows:

Column: Supelco Discovery HS F5 or equivalent pentafluorophenyl column,5 um, 50 × 2.1 mm. Flow rate: 0.6 mL/min. Mobile phase A: 0.1% formicacid in water. Mobile phase B: 0.1% formic acid in acetonitrile.Gradient: 5-70% B in 1.9 min. Mass spectrometer: Positive ion mode withelectrospray ionization. MS/MS: Biapenem − Q1 − m/e = 350.8, Q3 − m/e =110.1. meropenem − Q1 − m/e = 384.1, Q3 − m/e = 141.1.

Serum concentrations were determined using HPLC. Serum concentrationswere fit by using Non-compartmental model of WinNonlin Software(Pharsight. Version 5.3, Mountain View, Calif.).

The study groups, dose and dose route are illustrated in the tablebelow:

Number of Dose Animal per Route of (mg/kg) Time Points (hr) TimepointAdministration 25 0.08, 0.16, 0.25, 0.33, 0.5, 3 Intraperitoneal 0.75,1.0, 2.0, 3.0, 4.0 100 0.08, 0.16, 0.25, 0.33, 0.5, 3 Intraperitoneal0.75, 1.0, 2.0, 3.0, 4.0Results

The Plasma Pharmacokinetics of 25 mg/kg and 100 mg/kg of Biapenem afterintraperitoneal dose of 25 or 100 mg/kg in Swiss Webster Mice are shownin FIG. 2 and Table 9.

TABLE 9 Plasma Pharmacokinetic Parameters of Biapenem in Swiss-WebsterMice Dose Cl AUC Cmax T_(1/2) (mg/kg) (l/hr/kg) (hr * mg/kg) (mg/l) (h)25 1.6 15.56 31.2 0.17 100 0.96 103.55 286.0 0.21

The plasma standard curves of both studies were linear and used todetermine the plasma concentrations. The plasma standard curve andconcentrations are shown in Tables 10-13. The pharmacokinetic profile ofbiapenem was assessed in mice after single intraperitoneal doses of 25and 100 mg/kg. Data indicates that Biapenem has a linear PK inSwiss-Webster mice over the dose range of 25 to 100 mg/kg.

TABLE 10 Plasma Standard Curve for Pharmacokinetics of 100 mg/kg ofBiapenem Analyte Analyte Analyte Retention IS Peak Calc. Sample PeakArea Conc. Time Area Conc. Sample Name Type (counts) (ug/mL) (min) AreaRatio (counts) (ug/mL) mouse plasma blank Unknown 0 N/A 1.19 0.00E+0046500 No Peak mouse plasma blank + IS Unknown 0 N/A 1.11 0.00E+00 268000No Peak 0.01 ug/mL Biapenem in mouse plasma Unknown 5 N/A 0.955 1.91E−05262000 <0 0.02 ug/mL Biapenem in mouse plasma Unknown 155 N/A 1.35.74E−04 270000 0.0248 0.05 ug/mL Biapenem in mouse plasma Standard 3150.05 1.17 1.15E−03 275000 0.0551 0.1 ug/mL Biapenem in mouse plasmaStandard 578 0.1 1.18 2.17E−03 266000 0.109 0.2 ug/mL Biapenem in mouseplasma Standard 1190 0.2 1.17 4.33E−03 275000 0.224 0.5 ug/mL Biapenemin mouse plasma Standard 2960 0.5 1.17 1.11E−02 266000 0.582 1 ug/mLBiapenem in mouse plasma Standard 5910 1 1.17 2.18E−02 271000 1.15 2ug/mL Biapenem in mouse plasma Standard 10900 2 1.17 4.02E−02 2720002.13 5 ug/mL Biapenem in mouse plasma Standard 25600 5 1.19 9.85E−02260000 5.28 10 ug/mL Biapenem in mouse plasma Standard 49800 10 1.181.90E−01 262000 10.3 20 ug/mL Biapenem in mouse plasma Standard 95400 201.17 3.66E−01 261000 20.5 50 ug/mL Biapenem in mouse plasma Standard218000 50 1.15 8.29E−01 263000 50.7 100 ug/mL Biapenem in mouse plasmaStandard 413000 100 1.17 1.47E+00 282000 110 wash Unknown 5 N/A 1.192.76E−03 1810 0.141

TABLE 11 Plasma concentrations for Pharmacokinetics of 100 mg/kg ofBiapenem Analyte Peak Analyte Analyte IS Peak Area Conc. Retention AreaArea Calc. Conc. Sample Name Sample Type (counts) (ug/mL) Time (min)Ratio (counts) (ug/mL) mouse# 1.1 No dil. Unknown 692000 N/A 1.142.40E+00 288000 No Intercept mouse# 1.2 No dil. Unknown 3520 N/A 1.223.43E+00 1030 No Intercept mouse# 1.3 No dil. Unknown 705000 N/A 1.142.57E+00 274000 No Intercept mouse# 1.4 No dil. Unknown 297000 N/A 1.131.12E+00 264000 74.2 mouse# 1.5 No dil. Unknown 645 N/A 1.15 2.38E−03271000 0.120 mouse# 1.6 No dil. Unknown 142000 N/A 1.14 5.30E−01 26700030.5 mouse# 1.7 No dil. Unknown 53100 N/A 1.14 2.04E−01 260000 11.1mouse# 1.8 No dil. Unknown 1070 N/A 1.15 4.16E−03 258000 0.214 mouse#1.9 No dil. Unknown 88 N/A 1.1 3.38E−04 259000 0.0123 mouse# 1.10 Nodil. Unknown 80 N/A 1.09 2.97E−04 269000 0.0102 mouse# 2.1 No dil.Unknown 711000 N/A 1.15 2.67E+00 266000 No Intercept mouse# 2.2 No dil.Unknown 678000 N/A 1.14 2.54E+00 267000 No Intercept mouse# 2.3 No dil.Unknown 275000 N/A 1.14 1.06E+00 261000 68.4 mouse# 2.4 No dil. Unknown398000 N/A 1.14 1.49E+00 268000 113 mouse# 2.5 No dil. Unknown 720 N/A1.15 2.77E−03 260000 0.141 mouse# 2.6 No dil. Unknown 115000 N/A 1.154.44E−01 259000 25.2 mouse# 2.7 No dil. Unknown 525 N/A 1.12 2.05E−03256000 0.103 mouse# 2.8 No dil. Unknown 14900 N/A 1.14 5.42E−02 2760002.88 mouse# 2.9 No dil. Unknown 98 N/A 1.27 3.77E−04 259000 0.0144mouse# 2.10 No dil. Unknown 128 N/A 1.13 4.77E−04 268000 0.0197 mouse#3.1 No dil. Unknown 9190 N/A 1.13 3.35E−02 275000 1.77 mouse# 3.2 Nodil. Unknown 575000 N/A 1.15 2.18E+00 264000 No Intercept mouse# 3.3 Nodil. Unknown 832000 N/A 1.14 3.10E+00 269000 No Intercept mouse# 3.4 Nodil. Unknown 229000 N/A 1.15 8.78E−01 261000 54.4 mouse# 3.5 No dil.Unknown 853 N/A 1.18 3.25E−03 263000 0.166 mouse# 3.6 No dil. Unknown98500 N/A 1.15 3.76E−01 262000 21.1 mouse# 3.7 No dil. Unknown 510000N/A 1.17 1.88E+00 272000 No Intercept mouse# 3.8 No dil. Unknown 5380N/A 1.11 2.05E−02 263000 1.08 mouse# 3.9 No dil. Unknown 85 N/A 1.073.17E−04 268000 0.0112 mouse# 3.10 No dil. Unknown 118 N/A 1.14 4.51E−04260000 0.0183

TABLE 12 Plasma Standard Curve for lactamase of 25 mg/kg of BiapenemAnalyte Analyte Analyte Retention IS Peak Calc. Sample Peak Area Conc.Time Area Conc. Sample Name Type (counts) (ug/mL) (min) Area Ratio(counts) (ug/mL) mouse plasma blank Unknown 0 N/A 1.19 0.00E+00 46500 NoPeak mouse plasma blank + IS Unknown 0 N/A 1.11 0.00E+00 268000 No Peak0.01 ug/mL Biapenem in mouse plasma Unknown 5 N/A 0.955 1.91E−05 262000<0 0.02 ug/mL Biapenem in mouse plasma Unknown 155 N/A 1.3 5.74E−04270000 0.0248 0.05 ug/mL Biapenem in mouse plasma Standard 315 0.05 1.171.15E−03 275000 0.0551 0.1 ug/mL Biapenem in mouse plasma Standard 5780.1 1.18 2.17E−03 266000 0.109 0.2 ug/mL Biapenem in mouse plasmaStandard 1190 0.2 1.17 4.33E−03 275000 0.224 0.5 ug/mL Biapenem in mouseplasma Standard 2960 0.5 1.17 1.11E−02 266000 0.582 1 ug/mL Biapenem inmouse plasma Standard 5910 1 1.17 2.18E−02 271000 1.15 2 ug/mL Biapenemin mouse plasma Standard 10900 2 1.17 4.02E−02 272000 2.13 5 ug/mLBiapenem in mouse plasma Standard 25600 5 1.19 9.85E−02 260000 5.28 10ug/mL Biapenem in mouse plasma Standard 49800 10 1.18 1.90E−01 26200010.3 20 ug/mL Biapenem in mouse plasma Standard 95400 20 1.17 3.66E−01261000 20.5 50 ug/mL Biapenem in mouse plasma Standard 218000 50 1.158.29E−01 263000 50.7 100 ug/mL Biapenem in mouse plasma Standard 413000100 1.17 1.47E+00 282000 110 wash Unknown 5 N/A 1.19 2.76E−03 1810 0.141

TABLE 13 Plasma concentrations for Pharmacokinetics of 25 mg/kg ofBiapenem Analyte Analyte Analyte Retention IS Peak Calc. Sample PeakArea Conc. Time Area Conc. Sample Name Type (counts) (ug/mL) (min) AreaRatio (counts) (ug/mL) mouse# 1.1 No dil. Unknown 385 N/A 1.11 1.47E−03262000 0.0723 mouse# 1.2 No dil. Unknown 88400 N/A 1.18 3.42E−01 25900019.1 mouse# 1.3 No dil. Unknown 89700 N/A 1.17 3.59E−01 250000 20.0mouse# 1.4 No dil. Unknown 71600 N/A 1.16 2.76E−01 259000 15.2 mouse#1.5 No dil. Unknown 38900 N/A 1.15 1.51E−01 257000 8.18 mouse# 1.6 Nodil. Unknown 478 N/A 1.13 1.92E−03 249000 0.0959 mouse# 1.7 No dil.Unknown 7710 N/A 1.15 3.01E−02 256000 1.59 mouse# 1.8 No dil. Unknown505 N/A 1.27 2.04E−03 248000 0.102 mouse# 1.9 No dil. Unknown 0 N/A 1.130.00E+00 252000 No Peak mouse# 1.10 No dil. Unknown 0 N/A 1.01 0.00E+00252000 No Peak mouse# 2.1 No dil. Unknown 96200 N/A 1.16 3.85E−01 25000021.6 mouse# 2.2 No dil. Unknown 71400 N/A 1.15 2.74E−01 261000 15.1mouse# 2.3 No dil. Unknown 221000 N/A 1.16 8.44E−01 262000 51.8 mouse#2.4 No dil. Unknown 63100 N/A 1.15 2.42E−01 260000 13.3 mouse# 2.5 Nodil. Unknown 645 N/A 1.14 2.64E−03 245000 0.268 mouse# 2.6 No dil.Unknown 29500 N/A 1.16 1.13E−01 261000 6.07 mouse# 2.7 No dil. Unknown230 N/A 1.23 9.28E−04 248000 0.0436 mouse# 2.8 No dil. Unknown 348 N/A1.16 1.34E−03 259000 0.0656 mouse# 2.9 No dil. Unknown 0 N/A 1.10.00E+00 251000 No Peak mouse# 2.10 No dil. Unknown 0 N/A 1.07 0.00E+00265000 No Peak mouse# 3.1 No dil. Unknown 111000 N/A 1.14 4.28E−01259000 24.2 mouse# 3.2 No dil. Unknown 120000 N/A 1.16 4.72E−01 25400026.9 mouse# 3.3 No dil. Unknown 99400 N/A 1.14 3.86E−01 257000 21.7mouse# 3.4 No dil. Unknown 87500 N/A 1.16 3.38E−01 259000 18.8 mouse#3.5 No dil. Unknown 62800 N/A 1.15 2.41E−01 261000 13.2 mouse# 3.6 Nodil. Unknown 32100 N/A 1.16 1.25E−01 255000 6.75 mouse# 3.7 No dil.Unknown 19400 N/A 1.17 7.37E−02 263000 3.93 mouse# 3.8 No dil. Unknown575 N/A 1.13 2.28E−03 252000 0.115 mouse# 3.9 No dil. Unknown 0 N/A0.999 0.00E+00 259000 No Peak mouse# 3.10 No dil. Unknown 203 N/A 1.177.63E−04 265000 0.0348

Example 3

Example 3 provides a summary of the pharmacokinetic studies of CompoundI alone or in combination with Biapenem following a single intravenousinfusion dose in Sprague-Dawley rats. The pharmacokinetics of 20 mg/kgof Compound I, 20 mg/kg of Biapenem, and 20 mg/kg of Compound I incombination with 20 mg/kg of Biapenem after a 1.5 hour intravenousinfusion were discussed.

Materials and Methods

Biapenem power was purchased from Hisun Pharmaceuticals. Compound I wasprepared using the method described in the U.S. Publication 2012/0040932A1. 20 mg of biapenem was dissolved in 0.1 M NaH₂PO₄ for a basic stocksolution. 100 mg of Compound I was dissolved in 30% 1N NaOH to ˜pH 5.0.For animal studies, these stock solutions were further diluted in 0.9%saline to the appropriate concentration.

The specifications for animals used on this study were as follows:

Species: Rat Strain: Sprague-Dawley Gender: Male Source: Charles River(Hollister, CA) Number of Animals: 3 per study Body Weight Range:230-280 g at the start of the study

Upon receipt, animals were housed individually per cage in a room with acontrolled environment and were acclimated to laboratory conditions forat least 24 hours prior to the start of dosing. Animals were providedfood and water ad libitum. The health status of the animals wasdetermined during the acclimation period and unhealthy animals were notplaced on study. Each animal was identified by marking their tails withindelible ink and each cage was identified by animal, group, and studynumber.

After acclimation, rats (n=3) were administered single 20 mg/kgintravenous infusion doses of Compound I or Biapenem alone or incombination. Doses were infused over 1.5 hours via an indwelling femoralvein cannula. Plasma (˜0.3 mL) samples were collected from each rat atdesignated time points up to 24 hours. The time points are shown insection 2.9. Blood samples were centrifuged within 5 min of collectionat 12000 g for 5 min to obtain plasma. The plasma samples were stored on−80° C. until analyzed.

Compound I standard curves were prepared in rat plasma from 0.1 to 100μg/mL. 50 μl aliquots of sample were placed in 1.5 mL microcentrifugetubes. 20 μl of Compound II (10 μg/mL) was added as internal standard toeach sample or standard. 20 μl of 30% trichloroacetic acid was thenadded to each sample or standard. The samples were mixed using a vortexmixer centrifuged for 10 min at 15,000 RPM using a tabletop centrifuge.The supernatant (approx. 120 μl) was removed and added to 100 μl ofwater in a 96-well plate. The samples were mixed again using a vortexmixer. 10 μl of each sample was injected onto an HPLC-MS forquantification.

The HPLC-MS conditions for Compound I analysis are as follows:

Column: Phenomenex Fusion-RP or equivalent reversed-phase column, 5 um,50 × 2 mm. Flow rate: 0.6 mL/min. Mobile phase A: 0.1% formic acid inwater. Mobile phase B: 0.1% formic acid in acetonitrile. Gradient: 5-60%B in 1.5 min. Mass spectrometer: Negative ion mode with electrosprayionization. MS/MS: Compound I − Q1 − m/e = 296, Q3 − m/e = 234. CompoundII − Q1 − m/e = 331, Q3 − m/e = 201.

Biapenem standard curves were prepared in 50% plasma-50% 1M MOPS buffer,pH=7.4 from 1 to 250 ug/mL. 20 uL of sample or standard was added into a96-well deep well plate. Then 500 uL of 10% water-45% methanol-45%acetonitrile containing 2 ug/mL of meropenem was used as an internalstandard. The plate was vortexed for 15 min. at 3,000 RPM. 50 uL ofsupernatant was removed and added 300 uL of water. 10 uL of samples wereinjected onto an HPLC-MS system for quantification.

The HPLC-MS conditions for Biaphenem analysis are as follows:

Column: Supelco Discovery HS F5 or equivalent pentafluorophenyl column,5 um, 50 × 2.1 mm. Flow rate: 0.6 mL/min. Mobile phase A: 0.1% formicacid in water. Mobile phase B: 0.1% formic acid in acetonitrile.Gradient: 5-70% B in 1.9 min. Mass spectrometer: Positive ion mode withelectrospray ionization. MS/MS: Biapenem − Q1 − m/e = 350.8, Q3 − m/e =110.1. meropenem − Q1 − m/e = 384.1, Q3 − m/e = 141.1

Plasma concentrations were fit using a two compartment IV infusion model(WinNonlinVersion 5.3, Pharsight Corp, Mountain View, Calif.).

The study groups, dose and dose routes for the three pharmacokineticstudies are shown in the table below:

Number of Length of Dose Plasma Collection Time Animal per InfusionRoute of Compounds (mg/kg) Points (hr) Timepoint (hr) AdministrationCompound I + 20 + 20 0.5, 1, 1.5, 1.58, 1.67, 3 1.5 Intravenous InfusionBiapenem 1.75, 2, 3, 4, 6, 24 Compound I 20 Biapenem  0 + 20

The Sprague-Dawley rats plasma pharmacokinetics of 20 mg/kg of CompoundI and Biapenem alone or in combination are shown in FIGS. 3-6 and Table14.

TABLE 14 Pharmacokinetics of Biapenem and Compound I Administered Aloneor in Combination in Rats AUC (mg * h/L) Cl (L/hr/kg) Half-Life (hr)Biapenem PK Biapenem (alone)  8.95 ± 0.89 2.29 ± 0.24 0.21 ± 0.01Biapenem (with 10.07 ± 1.13 2.03 ± 0.22 0.22 ± 0.01 Compound I) CompoundI PK Compound I (alone) 10.98 ± 0.86 1.98 ± 0.12 0.72 ± 0.15 Compound I(with 10.44 ± 1.15 1.95 ± 0.21 0.39 ± 0.11 Biapenem)

The plasma standard curves of all three studies were linear and used todetermine the plasma concentrations. The plasma standard curve andconcentrations of three studies are shown in Tables 15-22. Thepharmacokinetic profiles of Compound I and Biapenem alone or incombination were assessed in rats after single intravenous infusion.Data shows that the plasma pharmacokinetic parameters for biapenem andCompound I in rats are similar to each other and are unchanged when theywere administered alone or in combination.

TABLE 15 Plasma Standard Curve of 20 mg/kg of Biapenem Analyte Peak AreaAnalyte Conc. Analyte Retention Area IS Peak Area Calc. Conc. SampleName (counts) (ug/mL) Time (min) Ratio (counts) (ug/mL) rat r.p..blank + IS 0 N/A 0 0.00E+00 975000 No Peak 0.01 ug/mL Biapenem 230 0.010.48 2.36E−04 974000 0.00754 & Compound I in rat r.p.. 0.02 ug/mLBiapenem 523 0.02 0.494 5.24E−04 998000 0.0209 & Compound I in rat r.p..0.05 ug/mL Biapenem 1250 0.05 0.49 1.28E−03 978000 0.0561 & Compound Iin rat r.p.. 0.1 ug/mL Biapenem 2370 0.1 0.49 2.51E−03 946000 0.114 &Compound I in rat r.p.. 0.2 ug/mL Biapenem 4230 0.2 0.49 4.43E−03 9550000.204 & Compound I in rat r.p.. 0.5 ug/mL Biapenem 10500 0.5 0.4851.10E−02 957000 0.518 & Compound I in rat r.p.. 1 ug/mL Biapenem & 212001 0.491 2.16E−02 978000 1.04 Compound I in rat r.p.. 2 ug/mL Biapenem &38900 2 0.486 4.25E−02 915000 2.12 Compound I in rat r.p.. 5 ug/mLBiapenem & 77900 5 0.486 8.56E−02 910000 4.72 Compound I in rat r.p.. 10ug/mL Biapenem & 132000 10 0.49 1.42E−01 936000 9.78 Compound I in ratr.p.. 20 ug/mL Biapenem & 219000 N/A 0.487 2.43E−01 901000 No InterceptCompound I in rat r.p.. 50 ug/mL Biapenem & 410000 N/A 0.485 4.44E−01923000 No Intercept Compound I in rat r.p.. 100 ug/mL Biapenem 617000N/A 0.492 6.79E−01 909000 No Intercept & Compound I in rat r.p..

TABLE 16 Plasma Concentrations of 20 mg/kg of Biapenem Analyte AnalyteAnalyte Retention IS Peak Calc. Peak Area Conc. Time Area Area Conc.Sample Name (counts) (ug/mL) (min) Ratio (counts) (ug/mL) r.p. # 1.1(Biapenem 20 mg/kg) 84000 N/A 0.481 9.70E−02 866000 5.53 r.p. # 1.2(Biapenem 20 mg/kg) 76700 N/A 0.496 8.94E−02 858000 4.99 r.p. # 1.3(Biapenem 20 mg/kg) 106000 N/A 0.49 1.28E−01 826000 8.18 r.p. # 1.4(Biapenem 20 mg/kg) 91000 N/A 0.482 1.08E−01 845000 6.4 r.p. # 1.5(Biapenem 20 mg/kg) 64100 N/A 0.486 7.60E−02 843000 4.09 r.p. # 1.6(Biapenem 20 mg/kg) 46000 N/A 0.485 5.56E−02 828000 2.85 r.p. # 1.7(Biapenem 20 mg/kg) 24800 N/A 0.485 3.06E−02 813000 1.49 r.p. # 1.8(Biapenem 20 mg/kg) 2140 N/A 0.49 2.60E−03 824000 0.118 r.p. # 1.9(Biapenem 20 mg/kg) 95 N/A 0.495 1.14E−04 835000 0.00185 r.p. # 1.10(Biapenem 20 mg/kg) 20 N/A 0.475 2.42E−05 826000 <0 r.p. # 1.10(Biapenem 20 mg/kg) 10 N/A 0.49 1.23E−05 801000 <0 r.p. # 2.1 (Biapenem20 mg/kg) 73700 N/A 0.482 9.07E−02 812000 5.08 No Sample N/A N/A N/A N/AN/A N/A r.p. # 2.3 (Biapenem 20 mg/kg) 83900 N/A 0.482 1.03E−01 8130006.01 r.p. # 2.4 (Biapenem 20 mg/kg) 59900 N/A 0.486 7.55E−02 794000 4.06r.p. # 2.5 (Biapenem 20 mg/kg) 34300 N/A 0.486 4.31E−02 796000 2.15 r.p.# 2.6 (Biapenem 20 mg/kg) 12500 N/A 0.481 1.53E−02 820000 0.725 r.p. #2.7 (Biapenem 20 mg/kg) 14900 N/A 0.49 1.84E−02 808000 0.878 r.p. # 2.8(Biapenem 20 mg/kg) 1570 N/A 0.491 2.02E−03 778000 0.0906 r.p. # 2.9(Biapenem 20 mg/kg) 93 N/A 0.474 1.17E−04 788000 0.00201 r.p. # 2.10(Biapenem 20 mg/kg) 418 N/A 0.488 5.29E−04 790000 0.0212 r.p. # 2.10(Biapenem 20 mg/kg) 0 N/A 0 0.00E+00 770000 No Peak r.p. # 3.1 (Biapenem20 mg/kg) 59800 N/A 0.49 7.91E−02 757000 4.29 r.p. # 3.2 (Biapenem 20mg/kg) 53500 N/A 0.491 6.95E−02 769000 3.68 r.p. # 3.3 (Biapenem 20mg/kg) 76800 N/A 0.487 1.02E−01 752000 5.92 r.p. # 3.4 (Biapenem 20mg/kg) 61400 N/A 0.489 7.65E−02 802000 4.12 r.p. # 3.5 (Biapenem 20mg/kg) 31100 N/A 0.494 4.15E−02 749000 2.07 r.p. # 3.6 (Biapenem 20mg/kg) 24500 N/A 0.49 3.30E−02 742000 1.62 r.p. # 3.7 (Biapenem 20mg/kg) 13200 N/A 0.486 1.73E−02 760000 0.824 r.p. # 3.8 (Biapenem 20mg/kg) 743 N/A 0.489 9.49E−04 783000 0.0407 r.p. # 3.9 (Biapenem 20mg/kg) 185 N/A 0.493 2.49E−04 743000 0.00814 r.p. # 3.10 (Biapenem 20mg/kg) 23 N/A 0.452 2.93E−05 769000 <0

TABLE 17 Plasma Standard Curve of 20 mg/kg of Compound I Analyte AnalyteAnalyte Retention IS Peak Peak Area Conc. Time Area Calc. Conc. SampleName (counts) (ug/mL) (min) Area Ratio (counts) (ug/mL) r.k.h. blank 0N/A 0 0.00E+00 8 No Peak rat r.p.. blank + IS 0 N/A 0 0.00E+00 134000 NoPeak 0.01 ug/mL Biapenem & Compound I in rat r.p.. 711 N/A 2.13 5.01E−03142000 0.0193 0.02 ug/mL Biapenem & Compound I in rat r.p.. 851 0.022.14 5.37E−03 158000 0.0217 0.05 ug/mL Biapenem & Compound I in ratr.p.. 1600 0.05 2.13 9.84E−03 163000 0.0509 0.1 ug/mL Biapenem &Compound I in rat r.p.. 2950 0.1 2.15 1.67E−02 177000 0.0959 0.2 ug/mLBiapenem & Compound I in rat r.p.. 6460 0.2 2.14 3.43E−02 188000 0.2110.5 ug/mL Biapenem & Compound I in rat r.p.. 14700 0.5 2.14 7.72E−02191000 0.493 1 ug/mL Biapenem & Compound I in rat r.p.. 32900 1 2.141.69E−01 195000 1.09 2 ug/mL Biapenem & Compound I in rat r.p.. 66000 22.14 3.15E−01 209000 2.07 5 ug/mL Biapenem & Compound I in rat r.p..165000 5 2.14 7.94E−01 208000 5.29 10 ug/mL Biapenem & Compound I in ratr.p.. 340000 10 2.14 1.59E+00 214000 10.8 20 ug/mL Biapenem & Compound Iin rat r.p.. 647000 20 2.14 2.99E+00 216000 21.2 50 ug/mL Biapenem &Compound I in rat r.p.. 1450000 50 2.14 6.47E+00 224000 52.5 100 ug/mLBiapenem & Compound I in rat r.p.. 2510000 100 2.14 1.05E+01 240000 NoIntercept wash 28500 N/A 2.13 9.49E+02 30 No Intercept

TABLE 18 Plasma Concentrations of 20 mg/kg of Compound I Analyte AnalyteAnalyte Peak Area Conc. Retention IS Peak Area Calc. Conc. Sample Name(counts) (ug/mL) Time (min) Area Ratio (counts) (ug/mL) r.p. # 4.1(Compound I 20 mg/kg) 344000 N/A 2.14 1.17E+00 294000 7.88 r.p. # 4.2(Compound I 20 mg/kg) 408000 N/A 2.14 1.55E+00 263000 10.6 r.p. # 4.3(Compound I 20 mg/kg) 417000 N/A 2.14 1.44E+00 289000 9.80 r.p. # 4.4(Compound I 20 mg/kg) 317000 N/A 2.14 1.12E+00 283000 7.51 r.p. # 4.6(Compound I 20 mg/kg) 135000 N/A 2.14 4.69E−01 288000 3.09 r.p. # 4.5(Compound I 20 mg/kg) 188000 N/A 2.14 6.47E−01 290000 4.29 r.p. # 4.7(Compound I 20 mg/kg) 68200 N/A 2.14 2.30E−01 297000 1.50 r.p. # 4.8(Compound I 20 mg/kg) 9100 N/A 2.14 3.00E−02 303000 0.183 r.p. # 4.9(Compound I 20 mg/kg) 2380 N/A 2.14 7.50E−03 317000 0.0356 r.p. # 4.10(Compound I 20 mg/kg) 3060 N/A 2.15 9.67E−03 316000 0.0498 r.p. # 4.10(Compound I 20 mg/kg) 372 N/A 2.12 1.19E−03 314000 <0 r.p. # 5.1(Compound I 20 mg/kg) 206000 N/A 2.15 6.70E−01 307000 4.45 r.p. # 5.2(Compound I 20 mg/kg) 72100 N/A 2.14 2.24E−01 321000 1.46 r.p. # 5.3(Compound I 20 mg/kg) 222000 N/A 2.15 6.83E−01 325000 4.53 r.p. # 5.4(Compound I 20 mg/kg) 159000 N/A 2.14 4.79E−01 333000 3.16 r.p. # 5.5(Compound I 20 mg/kg) 130000 N/A 2.14 3.96E−01 328000 2.61 r.p. # 5.6(Compound I 20 mg/kg) 92400 N/A 2.14 2.81E−01 329000 1.84 r.p. # 5.7(Compound I 20 mg/kg) 46000 N/A 2.14 1.38E−01 332000 0.896 r.p. # 5.8(Compound I 20 mg/kg) 7290 N/A 2.14 2.08E−02 351000 0.122 r.p. # 5.9(Compound I 20 mg/kg) 3130 N/A 2.15 9.21E−03 340000 0.0468 r.p. # 5.10(Compound I 20 mg/kg) 3300 N/A 2.15 9.56E−03 345000 0.0491 r.p. # 5.10(Compound I 20 mg/kg) 233 N/A 2.15 6.56E−04 354000 <0 r.p. # 6.1(Compound I 20 mg/kg) 346000 N/A 2.15 9.79E−01 354000 6.55 r.p. # 6.2(Compound I 20 mg/kg) 289000 N/A 2.14 8.17E−01 354000 5.44 r.p. # 6.3(Compound I 20 mg/kg) 294000 N/A 2.15 8.38E−01 350000 5.59 r.p. # 6.4(Compound I 20 mg/kg) 280000 N/A 2.14 7.87E−01 355000 5.24 r.p. # 6.5(Compound I 20 mg/kg) 159000 N/A 2.15 4.44E−01 359000 2.92 r.p. # 6.6(Compound I 20 mg/kg) 120000 N/A 2.15 3.19E−01 377000 2.09 r.p. # 6.7(Compound I 20 mg/kg) 57000 N/A 2.14 1.48E−01 385000 0.960 r.p. # 6.8(Compound I 20 mg/kg) 9680 N/A 2.14 2.66E−02 363000 0.161 r.p. # 6.9(Compound I 20 mg/kg) 4200 N/A 2.14 1.11E−02 380000 0.0589 r.p. # 6.10(Compound I 20 mg/kg) 3930 N/A 2.15 1.07E−02 366000 0.0567 r.p. # 6.10(Compound I 20 mg/kg) 274 N/A 2.15 7.19E−04 381000 <0

TABLE 19 Compound I Plasma Standard Curve of 20 mg/kg of Compound I inCombination with 20 mg/kg of Biapenem Analyte Analyte Analyte RetentionIS Peak Peak Area Conc. Time Area Calc. Conc. Sample Name (counts)(ug/mL) (min) Area Ratio (counts) (ug/mL) r.k.h. blank 0 N/A 0 0.00E+008 No Peak rat r.p.. blank + IS 0 N/A 0 0.00E+00 134000 No Peak 0.01ug/mL Biapenem & Compound I in rat r.p.. 711 N/A 2.13 5.01E−03 1420000.0193 0.02 ug/mL Biapenem & Compound I in rat r.p.. 851 0.02 2.145.37E−03 158000 0.0217 0.05 ug/mL Biapenem & Compound I in rat r.p..1600 0.05 2.13 9.84E−03 163000 0.0509 0.1 ug/mL Biapenem & Compound I inrat r.p.. 2950 0.1 2.15 1.67E−02 177000 0.0959 0.2 ug/mL Biapenem &Compound I in rat r.p.. 6460 0.2 2.14 3.43E−02 188000 0.211 0.5 ug/mLBiapenem & Compound I in rat r.p.. 14700 0.5 2.14 7.72E−02 191000 0.4931 ug/mL Biapenem & Compound I in rat r.p.. 32900 1 2.14 1.69E−01 1950001.09 2 ug/mL Biapenem & Compound I in rat r.p.. 66000 2 2.14 3.15E−01209000 2.07 5 ug/mL Biapenem & Compound I in rat r.p.. 165000 5 2.147.94E−01 208000 5.29 10 ug/mL Biapenem & Compound I in rat r.p.. 34000010 2.14 1.59E+00 214000 10.8 20 ug/mL Biapenem & Compound I in rat r.p..647000 20 2.14 2.99E+00 216000 21.2 50 ug/mL Biapenem & Compound I inrat r.p.. 1450000 50 2.14 6.47E+00 224000 52.5 100 ug/mL Biapenem &Compound I in rat r.p.. 2510000 100 2.14 1.05E+01 240000 No Interceptwash 28500 N/A 2.13 9.49E+02 30 No Intercept

TABLE 20 Compound I Plasma Concentrations of 20 mg/kg of Compound I inCombination with 20 mg/kg of Biapenem Analyte Analyte Peak AnalyteRetention IS Peak Area Conc. Time Area Area Calc. Conc. Sample Name(counts) (ug/mL) (min) Ratio (counts) (ug/mL) r.p. # 7.1 (Biapenem &Compound I 20 mg/kg) 355000 N/A 2.15 8.25E−01 430000 5.50 r.p. # 7.2(Biapenem & Compound I 20 mg/kg) 411000 N/A 2.14 1.08E+00 381000 7.24r.p. # 7.3 (Biapenem & Compound I 20 mg/kg) 321000 N/A 2.14 8.18E−01392000 5.45 r.p. # 7.4 (Biapenem & Compound I 20 mg/kg) 339000 N/A 2.158.46E−01 401000 5.64 r.p. # 7.5 (Biapenem & Compound I 20 mg/kg) 185000N/A 2.14 4.55E−01 406000 3.00 r.p. # 7.6 (Biapenem & Compound I 20mg/kg) 117000 N/A 2.14 2.95E−01 398000 1.93 r.p. # 7.7 (Biapenem &Compound I 20 mg/kg) 64300 N/A 2.14 1.63E−01 394000 1.06 r.p. # 7.8(Biapenem & Compound I 20 mg/kg) 6860 N/A 2.14 1.72E−02 398000 0.0994r.p. # 7.9 (Biapenem & Compound I 20 mg/kg) 2890 N/A 2.14 7.13E−03406000 0.0332 r.p. # 7.10 (Biapenem & Compound I 20 mg/kg) 7600 N/A 2.151.88E−02 405000 0.109 r.p. # 7.10 (Biapenem & Compound I 20 mg/kg) 402N/A 2.14 9.61E−04 418000 <0 r.p. # 8.1 (Biapenem & Compound I 20 mg/kg)354000 N/A 2.14 8.47E−01 417000 5.65 r.p. # 8.2 (Biapenem & Compound I20 mg/kg) 317000 N/A 2.14 7.32E−01 432000 4.87 r.p. # 8.3 (Biapenem &Compound I 20 mg/kg) 415000 N/A 2.14 9.59E−01 433000 6.41 r.p. # 8.4(Biapenem & Compound I 20 mg/kg) 159000 N/A 2.14 3.86E−01 411000 2.54r.p. # 8.5 (Biapenem & Compound I 20 mg/kg) 106000 N/A 2.14 2.54E−01417000 1.66 r.p. # 8.6 (Biapenem & Compound I 20 mg/kg) 60800 N/A 2.141.42E−01 428000 0.920 r.p. # 8.7 (Biapenem & Compound I 20 mg/kg) 37900N/A 2.14 9.08E−02 418000 0.582 r.p. # 8.8 (Biapenem & Compound I 20mg/kg) 2550 N/A 2.14 5.95E−03 429000 0.0254 r.p. # 8.9 (Biapenem &Compound I 20 mg/kg) 3030 N/A 2.13 6.95E−03 436000 0.0320 r.p. # 8.10(Biapenem & Compound I 20 mg/kg) 5140 N/A 2.13 1.22E−02 421000 0.0664r.p. # 8.10 (Biapenem & Compound I 20 mg/kg) 180 N/A 2.14 4.23E−04426000 <0 r.p. # 9.1 (Biapenem & Compound I 20 mg/kg) 286000 N/A 2.146.58E−01 435000 4.36 r.p. # 9.2 (Biapenem & Compound I 20 mg/kg) 431000N/A 2.14 9.42E−01 458000 6.30 r.p. # 9.3 (Biapenem & Compound I 20mg/kg) 465000 N/A 2.14 1.05E+00 441000 7.07 No Sample N/A N/A N/A N/AN/A N/A r.p. # 9.5 (Biapenem & Compound I 20 mg/kg) 206000 N/A 2.144.54E−01 455000 2.99 r.p. # 9.6 (Biapenem & Compound I 20 mg/kg) 102000N/A 2.14 2.32E−01 441000 1.51 r.p. # 9.7 (Biapenem & Compound I 20mg/kg) 65100 N/A 2.15 1.46E−01 445000 0.948 r.p. # 9.8 (Biapenem &Compound I 20 mg/kg) 4090 N/A 2.14 8.96E−03 457000 0.0451 r.p. # 9.9(Biapenem & Compound I 20 mg/kg) 1720 N/A 2.14 3.92E−03 439000 0.0121r.p. # 9.10 (Biapenem & Compound I 20 mg/kg) 13900 N/A 2.14 3.13E−02443000 0.191 r.p. # 9.10 (Biapenem & Compound I 20 mg/kg) 330 N/A 2.117.44E−04 444000 <0

TABLE 21 Biapenem Plasma Standard Curve of 20 mg/kg of Compound I inCombination with 20 mg/kg of Biapenem Analyte Analyte Peak AnalyteRetention IS Peak Area Conc. Time Area Area Calc. Conc. Sample Name(counts) (ug/mL) (min) Ratio (counts) (ug/mL) 0.01 ug/mL Biapenem &Compound I in rat r.p.. 711 N/A 2.13 5.01E−03 142000 0.0193 0.02 ug/mLBiapenem & Compound I in rat r.p.. 851 0.02 2.14 5.37E−03 158000 0.02170.05 ug/mL Biapenem & Compound I in rat r.p.. 1600 0.05 2.13 9.84E−03163000 0.0509 0.1 ug/mL Biapenem & Compound I in rat r.p.. 2950 0.1 2.151.67E−02 177000 0.0959 0.2 ug/mL Biapenem & Compound I in rat r.p.. 64600.2 2.14 3.43E−02 188000 0.211 0.5 ug/mL Biapenem & Compound I in ratr.p.. 14700 0.5 2.14 7.72E−02 191000 0.493 1 ug/mL Biapenem & Compound Iin rat r.p.. 32900 1 2.14 1.69E−01 195000 1.09 2 ug/mL Biapenem &Compound I in rat r.p.. 66000 2 2.14 3.15E−01 209000 2.07 5 ug/mLBiapenem & Compound I in rat r.p.. 165000 5 2.14 7.94E−01 208000 5.29 10ug/mL Biapenem & Compound I in rat r.p.. 340000 10 2.14 1.59E+00 21400010.8 20 ug/mL Biapenem & Compound I in rat r.p.. 647000 20 2.14 2.99E+00216000 21.2 50 ug/mL Biapenem & Compound I in rat r.p.. 1450000 50 2.146.47E+00 224000 52.5 100 ug/mL Biapenem & Compound I in rat r.p..2510000 100 2.14 1.05E+01 240000 No Intercept wash 28500 N/A 2.139.49E+02 30 No Intercept

TABLE 22 Biapenem Plasma Concentrations of 20 mg/kg of Compound I inCombination with 20 mg/kg of Biapenem Analyte Analyte Analyte RetentionIS Peak Calc. Peak Area Conc. Time Area Area Conc. Sample Name (counts)(ug/mL) (min) Ratio (counts) (ug/mL) r.p. # 7.1 (Biapenem & Compound I20 mg/kg) 74100 N/A 0.485 9.80E−02 756000 5.61 r.p. # 7.2 (Biapenem &Compound I 20 mg/kg) 84600 N/A 0.489 1.26E−01 672000 7.98 r.p. # 7.3(Biapenem & Compound I 20 mg/kg) 64200 N/A 0.487 9.08E−02 708000 5.08r.p. # 7.4 (Biapenem & Compound I 20 mg/kg) 75800 N/A 0.487 1.09E−01695000 6.47 r.p. # 7.5 (Biapenem & Compound I 20 mg/kg) 40200 N/A 0.4865.87E−02 685000 3.03 r.p. # 7.6 (Biapenem & Compound I 20 mg/kg) 27300N/A 0.488 3.81E−02 718000 1.89 r.p. # 7.7 (Biapenem & Compound I 20mg/kg) 17600 N/A 0.487 2.52E−02 698000 1.22 r.p. # 7.8 (Biapenem &Compound I 20 mg/kg) 1570 N/A 0.486 2.29E−03 684000 0.103 r.p. # 7.9(Biapenem & Compound I 20 mg/kg) 516 N/A 0.478 7.63E−04 675000 0.0321r.p. # 7.10 (Biapenem & Compound I 20 mg/kg) 1520 N/A 0.488 2.21E−03688000 0.100 r.p. # 7.10 (Biapenem & Compound I 20 mg/kg) 18 N/A 0.4612.53E−05 693000 <0 r.p. # 8.1 (Biapenem & Compound I 20 mg/kg) 54500 N/A0.488 8.08E−02 674000 4.40 r.p. # 8.2 (Biapenem & Compound I 20 mg/kg)63000 N/A 0.49 9.26E−02 680000 5.21 r.p. # 8.3 (Biapenem & Compound I 20mg/kg) 78500 N/A 0.493 1.18E−01 662000 7.28 r.p. # 8.4 (Biapenem &Compound I 20 mg/kg) 36600 N/A 0.489 5.31E−02 691000 2.71 r.p. # 8.5(Biapenem & Compound I 20 mg/kg) 25600 N/A 0.494 3.77E−02 678000 1.87r.p. # 8.6 (Biapenem & Compound I 20 mg/kg) 21700 N/A 0.487 3.11E−02697000 1.52 r.p. # 8.7 (Biapenem & Compound I 20 mg/kg) 12000 N/A 0.4921.74E−02 693000 0.828 r.p. # 8.8 (Biapenem & Compound I 20 mg/kg) 548N/A 0.481 8.33E−04 658000 0.0353 r.p. # 8.9 (Biapenem & Compound I 20mg/kg) 623 N/A 0.479 9.17E−04 679000 0.0393 r.p. # 8.10 (Biapenem &Compound I 20 mg/kg) 886 N/A 0.487 1.33E−03 664000 0.0587 r.p. # 8.10(Biapenem & Compound I 20 mg/kg) 0 N/A 0 0.00E+00 620000 No Peak r.p. #9.1 (Biapenem & Compound I 20 mg/kg) 51500 N/A 0.487 7.24E−02 7120003.86 r.p. # 9.2 (Biapenem & Compound I 20 mg/kg) 83800 N/A 0.4911.19E−01 703000 7.34 r.p. # 9.3 (Biapenem & Compound I 20 mg/kg) 89400N/A 0.487 1.37E−01 653000 9.20 No Sample N/A N/A N/A N/A N/A N/A r.p. #9.5 (Biapenem & Compound I 20 mg/kg) 56100 N/A 0.49 8.82E−02 636000 4.90r.p. # 9.6 (Biapenem & Compound I 20 mg/kg) 29000 N/A 0.487 4.31E−02672000 2.16 r.p. # 9.7 (Biapenem & Compound I 20 mg/kg) 24000 N/A 0.4863.44E−02 697000 1.69 r.p. # 9.8 (Biapenem & Compound I 20 mg/kg) 1080N/A 0.488 1.59E−03 681000 0.0705 r.p. # 9.9 (Biapenem & Compound I 20mg/kg) 100 N/A 0.494 1.49E−04 670000 0.00349 r.p. # 9.10 (Biapenem &Compound I 20 mg/kg) 2960 N/A 0.494 4.26E−03 694000 0.196 r.p. # 9.10(Biapenem & Compound I 20 mg/kg) 10 N/A 0.483 1.51E−05 660000 <0

Example 4

The evaluation of Compound I in combination with the carbapenemantibiotic Biapenem against multi-drug resistant strains ofEnterobacteriaceae, including those producing serine carbapenemases werealso conducted. Antibiotic potentiation activity of Compound I wasstudied in checkerboard MIC experiments and time-kill assays. The MICsof Biapenem were determined alone or in combination with Compound Iadded at fixed concentrations between 0.5 and 16 ug/ml) againstcharacterized and engineered isolates producing various beta-lactamases,as well as in geographically diverse panels of multi-drug resistantstrains of Enterobacteriaceae (including strains that express the mostrelevant beta-lactamases).

Biapenem MICs against KPC-producing strains including those expressingmultiple classes of enzymes ranged between 8 and 64 μg/ml. The additionof Compound I was associated with marked potentiation in characterizedstrains of Enterobacteriaceae with serine carbapenemases; Biapenem MICswere ≤0.25 μg/ml in the presence of 0.3 to 5 μg/ml of Compound I.Time-kill studies in KPC-producing strains (Biapenem MICs of 16-32ug/ml) demonstrated significant bactericidal synergism by the additionof Compound I. In the multi-drug resistant isolate panel ofEnterobacteriaceae (MIC90>32 for fluoroquinolones, aminoglycosides,cephalosporins, aztreonam and pip/tazo), the MIC90 of Biapenem (with 4ug/ml Compound I) was 0.5 ug/ml. Biapenem showed potency similar tomeropenem against P. aeruginosa, with no enhancement with the additionof Compound I. The results suggest that Compound I combined with thecarbapenem Biapenem is a highly active against Gram-negative pathogens,particularly against carbapenem-resistant Enterobacteriaceae and serinecarbapenemases such as KPC.

Example 5

Example 5 provides the single-dose pharmacokinetic studies of Compound Iinpreclinical species, including intraperitoneal administration toSwiss-Webster mice and intravenous administration to Sprague-Dawleyrats, Beagle dogs, and Cynomologus monkeys.

Intravaneous doses of Compound I were administered as 30-minuteinfusions. The pharmacokinetics of Compound I were also studied withcoadministration of the carbapenem, Biapenem. Compound I concentrationswere determined using an LC-MS detection method.

The mean pharmacokinetic parameters for Compound I are shown in Table 23below. Compound I showed linear and favorable pharmacokinetic propertiesacross all species, with clearance and volume of distribution comparableto those reported for beta-lactam antibiotics in these species.Clearance and volume of distribution were independent of dose. No PKdrug interactions between Compound I and Biapenem were observed.

TABLE 23 Pharmacokinetics Studies of Preclinical Species Dose (mg/kg)/C_(max) AUC CL or CL/F V_(ss) or V_(ss)/F T_(1/2) Species Route (μg/mL)(μg · h/mL) (L/kg/h) (L/kg) (h) Mouse  5 IP  8.26 3.1 1.61 0.38 0.16Mouse 15 IP 19.50  8.30 1.80 0.50 0.20 Mouse 50 IP 67.09 31.35 1.60 0.600.25 Rat 20 IV  19.8 ± 0.84  12.2 ± 0.43  1.7 ± 0.06 0.79 ± 0.07  1.6 ±0.17 Rat 50 IV  45.9 ± 2.00 28.2 ± 2.0  1.8 ± 0.13 1.31 ± 0.37  4.5 ±1.34 Dog  2 IV  6.49 ± 0.31  6.13 ± 0.65 0.33 ± 0.03 0.25 ± 0.02 0.66 ±0.06 Dog  6 IV 19.56 ± 1.42 18.39 ± 2.36 0.33 ± 0.04 0.26 ± 0.01 0.71 ±0.09 Dog 20 IV 66.79 ± 6.16 73.64 ± 5.38 0.27 ± 0.02 0.27 ± 0.03 1.53 ±0.73 Monkey  2 IV  5.35 ± 0.28  3.96 ± 0.51 0.51 ± 0.07 0.26 ± 0.01 0.57± 0.03 Monkey  6 IV 17.04 ± 1.68 12.19 ± 1.89 0.50 ± 0.08 0.24 ± 0.010.55 ± 0.12 Monkey 20 IV 54.89 ± 3.32 41.84 ± 2.53 0.48 ± 0.03 0.26 ±0.03 1.89 ± 1.73

Example 6

Example 6 provides the in vivo efficacy study of the carbapenem Biapenemin combination with Compound I in mouse models of pulmonary and thighinfection due to the carbapenem-resistant, KPC-producing K. pneumoniae.

Four K. pneumoniae strains with Biapenem MICs ranging between 0.25-64mg/L were used. Neutropenic mice were infected with ˜10⁵ CFU/lung or˜10⁶ CFU/thigh. Intraperitoneal treatments with 50 mpk Biapenem+/−50 mpkCompound I were initiated 2 hours post-infection as a single dose orcontinued every two hours for 24 hours. Mice were sacrificed ondesignated time points and colony counts in tissue determined.

In KPC-producing strains, treatment with Biapenem/Compound I producedsignificantly lower bacterial counts in tissues compared to Biapenemalone groups in both infection models. In lung infection, the extent ofbacterial killing after an hour of a single dose was up to 1.3 log CFUgreater than that in the control (Biapenem alone) group. The thighinfection model data is shown in Table 24 below. Treatment withBiapenem/Compound I produced significant bacterial killing in both themurine thigh and lung infection models using strains resistant toBiapenem treatment. These data show this combination to be a promisingtherapeutic option for the treatment of infections caused by KPCproducing strains.

TABLE 24 In vivo Efficacy of Biapenem/Compound I Combination BiapenemMIC (μg/mL) with Change in Log Compound I CFU/thigh ± Strain Alone (5μg/mL) Compound SD @ 24 h ATCC 43816 0.25 0.25 Biapenem −1.09 ± 0.30Biapenem + −1.33 ± 0.41 Compound I KP1004 16 ≤0.06 Biapenem +0.71 ± 0.10Biapenem + −0.91 ± 0.15 Compound I KP1061 32 ≤0.06 Biapenem +1.67 ± 0.09Biapenem + −0.69 ± 0.09 Compound I KP1074 64 0.25 Biapenem +0.98 ± 0.46Biapenem + −1.25 ± 0.24 Compound I

What is claimed is:
 1. A method for treating a bacterial infection in ahuman, comprising administering to a subject in need thereof acomposition comprising Compound I or a pharmaceutically acceptable saltthereof and a carbapenem antibacterial agent to achieve an in vivoCompound I plasma concentration C_(max) from about 50 mg/L to about 200mg/L, wherein Compound I has the structure:

and wherein Compound I is administered in a dose range from about 15mg/kg to about 50 mg/kg of body weight.
 2. The method of claim 1,wherein the carbapenem antibacterial agent is selected from the groupconsisting of Imipenem, Biapenem, Doripenem, Meropenem, and Ertapenem.3. The method of claim 2, wherein the carbapenem antibacterial agent isBiapenem.
 4. The method of claim 1, wherein the composition isadministered intravenously.
 5. The method of claim 1, wherein theinfection is caused by a bacteria selected from Pseudomonas aeruginosa,Pseudomonas aeruginosa, Pseudomonas fluorescens, Stenotrophomonasmaltophilia, Escherichia coli, Citrobacter freundii, Salmonellatyphimurium, Salmonella typhi, Salmonella paratyphi, Salmonellaenteritidis, Shigella dysenteriae, Shigella flexneri, Shigella sonnei,Enterobacter cloacae, Enterobacter aerogenes, Klebsiella pneumoniae,Klebsiella oxytoca, Serratia marcescens, Acinetobacter calcoaceticus,Acinetobacter haemolyticus, Yersinia enterocolitica, Yersinia pestis,Yersinia pseudotuberculosis, Yersinia intermedia, Haemophilusinfluenzae, Haemophilus parainfluenzae, Haemophilus haemolyticus,Haemophilus parahaemolyticus, Helicobacter pylori, Campylobacter fetus,Campylobacter jejuni, Campylobacter coli, Vibrio cholerae, Vibrioparahaemolyticus, Legionella pneumophila, Listeria monocytogenes,Neisseria gonorrhoeae, Neisseria meningitidis, Moraxella, Bacteroidesfragilis, Bacteroides vulgatus, Bacteroides ovalus, Bacteroidesthetaiotaomicron, Bacteroides uniformis, Bacteroides eggerthii, andBacteroides splanchnicus..
 6. The method of claim 1, wherein thecomposition further comprises an additional medicament selected from anantibacterial agent, antifungal agent, an antiviral agent, ananti-inflammatory agent, or an anti-allergic agent.
 7. The method ofclaim 2, wherein the carbapenem antibacterial agent is meropenem.
 8. Amethod for treating a bacterial infection in a human, comprisingadministering to a subject in need thereof a composition comprisingCompound I or a pharmaceutically acceptable salt thereof and acarbapenem antibacterial agent to achieve an in vivo Compound I 24 h AUCfrom about 45 mg*h/L to about 500 mg*h/L, wherein Compound I has thestructure:

and wherein Compound I is administered in a dose range from about 15mg/kg to about 50 mg/kg of body weight.
 9. The method of claim 8,wherein the carbapenem antibacterial agent is selected from the groupconsisting of Imipenem, Biapenem, Doripenem, Meropenem, and Ertapenem.10. The method of claim 9, wherein the carbapenem antibacterial agent isBiapenem.
 11. The method of claim 8, wherein the composition isadministered intravenously.
 12. The method of claim 8, wherein theinfection is caused by a bacteria selected from Pseudomonas aeruginosa,Pseudomonas aeruginosa, Pseudomonas fluorescens, Stenotrophomonasmaltophilia, Escherichia coli, Citrobacter freundii, Salmonellatyphimurium, Salmonella typhi, Salmonella paratyphi, Salmonellaenteritidis, Shigella dysenteriae, Shigella flexneri, Shigella sonnei,Enterobacter cloacae, Enterobacter aerogenes, Klebsiella pneumoniae,Klebsiella oxytoca, Serratia marcescens, Acinetobacter calcoaceticus,Acinetobacter haemolyticus, Yersinia enterocolitica, Yersinia pestis,Yersinia pseudotuberculosis, Yersinia intermedia, Haemophilusinfluenzae, Haemophilus parainfluenzae, Haemophilus haemolyticus,Haemophilus parahaemolyticus, Helicobacter pylori, Campylobacter fetus,Campylobacter jejuni, Campylobacter coli, Vibrio cholerae, Vibrioparahaemolyticus, Legionella pneumophila, Listeria monocytogenes,Neisseria gonorrhoeae, Neisseria meningitidis, Moraxella, Bacteroidesfragilis, Bacteroides vulgatus, Bacteroides ovalus, Bacteroidesthetaiotaomicron, Bacteroides uniformis, Bacteroides eggerthii, andBacteroides splanchnicus.
 13. The method of claim 8, wherein thecomposition further comprises an additional medicament selected from anantibacterial agent, antifungal agent, an antiviral agent, ananti-inflammatory agent, or an anti-allergic agent.
 14. The method ofclaim 9, wherein the carbapenem antibacterial agent is meropenem.